Safety and Efficacy of Temperature-Guided Radiofrequency Ablation for Ventricular Tachycardia

BACKGROUND A catheter platform allowing power- and temperature-controlled ablation (temperature-guided ablation) has recently been introduced. Clinical outcomes after ventricular tachycardia (VT) ablation using this technology remain uncertain. OBJECTIVES The goal of this study was to evaluate the safety and efficacy of temperature-guided VT ablation and compare the findings vs those from standard power-controlled ablation. METHODS This multicenter cohort study enrolled consecutive patients undergoing temperature-guided VT ablation using the QDOT MICRO catheter (Biosense Webster) at 8 referral centers in Europe and the United States (2021-2024). For comparison, a multicenter cohort of patients receiving power-controlled ablation with the THERMOCOOL SMARTTOUCH or SMARTTOUCH SurroundFlow (Biosense Webster) catheters was also included. The primary safety endpoint was procedure-related complications. The primary efficacy endpoint was sustained VT/ventricular fibrillation recurrence during long-term follow-up, assessed in the overall cohort and in propensity score-matched patients. RESULTS The study included 286 patients: 109 treated with temperature-guided ablation and 177 with power-controlled ablation. Ischemic cardiomyopathy was the predominant VT substrate (n = 125 [44%]); approximately one-half presented with electrical storm. Propensity score matching based on baseline clinical data yielded 101 pairs. Procedure-related complications were significantly lower with temperature-guided ablation (temperature-guided: n = 3 [3%]; power-controlled: n = 23 [13%]; P = 0.003), a result that remained significant after matching (temperature-guided: n = 3 [3%]; power-controlled: n = 12 [12%]; P = 0.028) and excluding vascular complications (temperature-guided: n = 1 [1%]; power-controlled: n = 14 [8%]; P = 0.012). Use of temperature-guided ablation was associated with lower odds of nonvascular complications in multivariable analysis (adjusted OR: 0.095; P = 0.028). Over a median follow-up of 24 months, VT/ventricular fibrillation recurrence rates were similar between groups in both overall (log-rank test, P = 0.570) and matched (log-rank test, P = 0.850) cohorts. Subgroup analyses showed no signal of heterogeneity. CONCLUSIONS In this multicenter VT ablation registry, a novel temperature-guided ablation modality showed favorable safety and efficacy relative to power-controlled ablation.