Computed tomography-guided vs conventional catheter ablation for ventricular tachycardia: the InEurHeart trial.

Ventricular tachycardia ablation guided by pre-procedural imaging was shown promising in non-randomized trials.

术前影像引导的室性心动过速消融术在非随机试验中显示出有希望的结果。

InEurHeart aims to evaluate computed tomography (CT)-guided VT ablation vs conventional ablation in a multicentre randomized controlled trial.

InEurHeart旨在在多中心随机对照试验中评估计算机断层扫描(CT)引导的心室颤动(VT)消融与传统消融的疗效。

Methods

In 14 European centres, 113 patients with prior myocardial infarction and clinically significant VT were randomly assigned to CT-guided (n = 57) or conventional (n = 56) VT ablation.

在14个欧洲中心，113名有既往心肌梗死和临床显著VT的患者被随机分配接受CT引导(n = 57)或传统(n = 56)VT消融。

The primary objective was to demonstrate reduced procedural duration when using CT guidance.

主要目标是证明使用CT引导时程序持续时间的减少。

Secondary endpoints included efficacy (incidenceand burden of ventricular arrhythmia), safety, as well as composite endpoints.

次要终点包括疗效（室性心律失常的发生率和负担）、安全性以及复合终点。

Results

The primary endpoint showed a significant decrease in procedure time favouring CT-guided ablation: 149 ± 51 to 120 ± 50 min, -19% [95% confidence interval(CI) -32; -7]; P = .0027 in intention to treat, and 149 ± 51 to 107 ± 38 min, -28% (95% CI -40; -16); P < .0001 per protocol.

主要终点显示，与常规手术相比，CT引导消融手术时间显著减少：从149 ± 51分钟减少到120 ± 50分钟，减少了19% [95%置信区间（CI）-32; -7]；意向治疗分析显示P = .0027，而按方案分析显示从149 ± 51分钟减少到107 ± 38分钟，减少了28% (95% CI -40; -16)；P < .0001。

Major adverse events occurred in two (3.5%) in the conventional group vs one (1.8%) in the CT-guided group [-1.8% (95% CI -7.9; 4.3)].

主要不良事件在常规组中发生2例（3.5%），而在CT引导组中发生1例（1.8%）[-1.8% (95% CI -7.9; 4.3)]。

Ventricular tachycardia-free survival at 1 year was achieved in 37 (67.3%) patients for conventional vs 43 (76.8%) for CT-guided VT ablation [9.5% (95% CI -10.4; 29.4), P = NS].

在常规治疗组中，有37名（67.3%）患者在1年内实现了无室性心动过速生存，而在CT引导下的室性心动过速消融治疗组中，有43名（76.8%）患者实现了无室性心动过速生存[9.5% (95% 置信区间 -10.4; 29.4), P = NS]。

Ventricular tachycardia burden was decreased by 90% in the CT-guided group.

CT引导组的室性心动过速负荷减少了90%。

Conclusions

In patients with ischaemic cardiomyopathy, CT-guided VT ablation reduces the procedure duration while maintaining a favourable efficacy and safety profile when compared with VT ablation without image integration.

在缺血性心肌病患者中，CT引导的室性心动过速（VT）消融在与无影像融合的VT消融相比时，缩短了手术时间，同时保持了良好的疗效和安全性。