Primary Endo- and Epicardial vs. Endocardial Ablation of Sustained Ventricular Tachycardia in Patients With Underlying Cardiac Disease (VTeee)
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- recurrence of any VT
研究概览
简要总结
A significant portion of patients with cardiac diseases like coronary artery disease (CAD), dilated cardiomyopathy (DCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) develops ventricular tachycardia (VT). The standard ablation procedure is carried out from endocardial only. In 30% of patients treated this way a successful ablation is not possible. In these cases the scar areas are mostly located in the outer layer of the myocardium. Ablation is feasible only if the catheter is placed in the epicardial space to reach the surface of the heart muscle. In the past this type of ablation was performed as a second procedure in case of recurrent VTs after unsuccessful endocardial ablation.
This prospective randomized trial compares the standard ablation procedure (endocardial ablation only) with a new strategy. This means in a single procedure the scar areas responsible for VT are marked and obliterated from endocardial as well as from epicardial. The primary endpoint is recurrence of VT after endo- and epicardial vs. endocardial ablation only.
40 patients will be enrolled. They will be randomized 1:1 in the study arms "strategy 1" which is standard endocardial ablation and "strategy 2" which is endo- and epicardial ablation.
At least 12 months are planned for enrollment. The study is closed if the patient last enrolled has completed the 12-months-follow up. Follow up visits are scheduled 3, 6 and 12 months after the ablation procedure. Recurrence of VT is monitored by ICD (implanted cardioverter defibrillator) interrogation.
Both ablation strategies are well established and conducted with standard equipment. The methodology of this study does not contain any experimental approaches. The standard insurance coverage of the hospital is guaranteed for all enrolled patients.
详细描述
A significant portion of patients with cardiac diseases like coronary artery disease (CAD), dilated cardiomyopathy (DCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC) develops ventricular tachycardia (VT). These arrhythmia often causes symptoms like dizziness, shortness of breath, angina or even cardiogenic shock. Large trials showed that VTs are associated with a 3.4 to 5fold increase in mortality even if each episode was successfully terminated by an ICD. Initially most patients are treated with antiarrhythmics. If these drugs are ineffective or not tolerated because of side effects catheter ablation (obliteration of cardiac tissue by radiofrequency) is the only alternative therapy.
The mechanism of most VTs are reentry circuits which are typically found in areas of scar in the left or right chamber. These scar areas may be located in the inner layer of the myocardium (endocardial), in the outer layer (epicardial) or in all layers of the heart muscle (transmural). The standard ablation procedure is carried out from endocardial only. This means catheters introduced through the femoral veins or arteries are placed in the right or left ventricle. In 30% of patients treated this way a successful ablation is not possible. In these cases the scar areas are mostly located in the outer layer of the myocardium. Ablation is feasible only if the catheter is placed in the epicardial space to reach the surface of the heart muscle. In the past this type of ablation was performed as a second procedure in case of recurrent VTs after unsuccessful endocardial ablation.
This prospective randomized trial compares the standard ablation procedure (endocardial ablation only) with a new strategy. This means in a single procedure the scar areas responsible for VT are marked and obliterated from endocardial as well as from epicardial. The primary endpoint is recurrence of VT after endo- and epicardial vs. endocardial ablation only.
Patients are eligible if they show documented VT on the basis of an underlying cardiac disease and a therapy with antiarrhythmics was ineffective or not tolerated. In terms of this study cardiac disease means CAD, DCM and ARVC. All patients have to be treated with an ICD. Patients are not eligible if VT is not documented, if there is no structural heart disease, if they have a mechanical aortic valve or a pacemaker/ICD with epicardial leads implanted or if a pericardial puncture must not be done.
40 patients will be enrolled. They will be randomized 1:1 in the study arms "strategy 1" which is standard endocardial ablation and "strategy 2" which is endo- and epicardial ablation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 80 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •structural heart disease (CAD, DCM, ARVC)
- •ICD already implanted
- •documented ventricular tachycardia
- •patient is able to give informed consent
- •VT ablation because of vital indication
排除标准
- •VT without structural cardiac disease
- •VT not documented
- •patient is not able to give informed consent
- •contraindication for pericardial puncture
- •mechanical aortic valve
- •pacemaker or ICD with an epicardial lead
结局指标
主要结局
recurrence of any VT
时间窗: up to 12 months after the date of VT ablation
Recurrence of any VT is measured by ICD interrogation, which is routinely done at the following follow-up visits: 3, 6 and 12 months after the date of the VT ablation procedure. In case of emergency (e.g. incessant VT, VT storm, resuscitation due to ventricular fibrillation) an additional ICD interrogation is done at admission to hospital.
次要结局
- 12 lead ECG features typical for epicardial VT substrates(date of VT ablation up to 3 to 5 days)
- percentage of VT substrates which can only be abolished by epicardial ablation(date of VT ablation - up to 3 to 5 days)
- percentage of epicardial VT substrates referred to the underlying cardiac disease(date of VT ablation - up to 3 to 5 days)
研究者
Dietmar Baensch
Prof. Dr. Dietmar Baensch
University of Rostock