Safety and Efficacy of Temperature-Guided Radiofrequency Ablation for Ventricular Tachycardia: A Multicenter Study

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.