Preventive Ablation of Ventricular Tachycardia in Patients With Myocardial Infarction - BERLIN VT

Feb 10, 2020
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Author/Summarized by Author:
Anthony A. Bavry, MD,MPH,FACC
Summary Reviewer:
Deepak L. Bhatt, MD, MPH, MBA, FACC
Trial Sponsor:
Biotronik SE & Co. KG, Berlin, Germany
Date Published:
01/31/2020
Date Updated:
02/10/2020
Original Posted Date:
02/10/2020
References

Contribution To Literature:

The BERLIN VT trial failed to show that preventive versus deferred VT ablation was superior at improving survival and preventing hospitalizations.

Description:

The goal of the trial was to evaluate preventive ventricular tachycardia (VT) ablation compared with deferred VT ablation among patients undergoing implantable cardioverter-defibrillator (ICD) implantation.

Study Design

  • Randomized
  • Parallel

Patients undergoing ICD implantation were randomized to preventive VT ablation (n = 76) versus deferred VT ablation (n = 83).

  • Total number of enrollees: 163
  • Duration of follow-up: 12 months
  • Mean patient age: 66 years
  • Percentage female: 12%
  • Percentage with diabetes: 30%

Inclusion criteria:

  • Prior myocardial infarction with stable ischemic cardiomyopathy
  • Left ventricular ejection fraction between 30% and 50%
  • Documented VT

Exclusion criteria:

  • Age <18 years or >80 years
  • New York Heart Association class IV heart failure
  • Acute myocardial reinfarction or acute coronary syndrome
  • Incessant VT or electrical storm
  • Bundle-branch reentry tachycardia as the presenting VT
  • Pre-existing ICD
  • Valvular heart disease or mechanical heart valve precluding access to the left ventricle
  • Known arterial or venous thrombosis
  • Cardiac surgery involving cardiotomy within the past 2 months
  • Thrombocytopenia or coagulopathy

Other salient features/characteristics:

  • Acute ablation success 80%

Principal Findings:

The trial was terminated early due to futility (78% completed enrollment).

The primary outcome, composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure at 12 months, occurred in 32.9% of the preventive ablation group compared with 27.7% of the deferred ablation group (p < 0.001).

Secondary outcomes:

  • All-cause mortality at 12 months: 7.9% of preventive ablation group compared with 2.4% of deferred ablation group (p = 0.18)
  • Hospitalization for worsening heart failure at 12 months: 10.4% of preventive ablation group compared with 2.4% of deferred ablation group (p = 0.062)
  • Hospitalization for VT at 12 months: 19.5% of preventive ablation group compared with 25.3% of deferred ablation group (p = 0.27)

References:

Willems S, Tilz RR, Steven D, et al., on behalf of the BERLIN VT Investigators. Preventive or Deferred Ablation of Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy and Implantable Defibrillator (BERLIN VT): A Multicenter Randomized Trial. Circulation 2020;Jan 31:[Epub ahead of print].

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Catheter Ablation, Defibrillators, Implantable, Heart Failure, Myocardial Infarction, Myocardial Ischemia, Secondary Prevention, Stroke Volume, Tachycardia, Ventricular


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