Effect of Multielectrode Versus Point-by-Point Mapping on Recurrence of Ventricular Tachycardia in Ischemic Heart Disease - A Prospective, Randomised Single Centre Trial
试验速览
- 阶段
- 不适用
- 状态
- 暂停
- 入组人数
- 180
- 试验地点
- 2
- 主要终点
- VT recurrence
研究概览
简要总结
VT ablation is a frequently performed intervention in patients with symptomatic ventricular tachycardia, electrical storm due to monomorphic VT and appropriate ICD shocks, primarily aiming at reducing the burden of complaints, and ICD shocks. The recommendations for its use were described in the ESC guideline for ventricular arrhythmias and the prevention of sudden cardiac death. To visualize the arrhythmogenic substrate leading to ventricular tachycardia complex mapping techniques are currently used in clinical routine, including conventional Point-by-Point mapping or Multielectrode Mapping. The latter is associated with shorter Mapping and overall procedure times, while maintaining the same primary endpoint of the procedure itself. The aim of this trial is to validate, whether the reduction of mapping and procedure time is associated with a comparable long-term outcome compared with conventional Point-by-Point mapping.
详细描述
Catheter Ablation in Patient with VT and ischemic heart disease has shown a beneficial effect in terms of VT Recurrence and Quality of life. The short-term outcome of catheter Ablation in Patients with this particular disease is good, but VT recurrence during long-term follow up is as high as 50-70%.
An integral Part of the Ablation procedure is the substance guided Mapping for localisation of low Voltage areas, late diastolic or fractioned potentials, as possible substrate for VT maintenance. These diastolic pathways, which represent slow conducting myocardium, are the major prerequisites for Reentry and thus for ventricular tachycardia.
Commonly these diastolic pathways are found in myocardial scar after infarction. Cardiac MRI can help to visualize these scars. In Patients with non-ischemic cardiomyopathy, the physician has to rely on intraprocedural Mapping and localisation of pathologic signals mentioned above.
In the last few years, the use of Multielectrode Mapping catheters becomes more and more part of complex EP procedures, mainly due to a high spatio temporal resolution, thereby reducing the overall Mapping time while maintaining the same primary endpoint of VT-non-inducibility compared to Point-by-Point Mapping.
There is growing evidence, that Multielectrode Mapping is associated with lesser mapping and procedure time, while generating more elecatroanatomical points (and thus more information regarding the arrhythmogenic substrate, responsible for VT maintenance).
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
- •Age ≥18 years.
- •Symptomatic ventricular tachycardia with/without ICD and underlying ischemic
- •No need for coronary revascularisation therapy based on coronary angiography or Cardiac MRI
- •Class I or IIa indication for catheter ablation (according to 2015 Guidelines of the European Society of Cardiology for the management of ventricular tachycardias).
- •Signed informed consent.
排除标准
- •Patients with ventricular assist device
- •Reversible causes of ventricular tachycardia (e. g. thyroid disorder, acute alcohol intoxication, recent major surgical procedures, trauma or acute infection/acute myocarditis)
- •Recent cardiovascular event including myocardial infarction, percutaneous intervention, valve or cardiac bypass surgery
- •Previous VT ablation within the last 3 months
- •Patients with ventricular tachycardia and known atrial fibrillation with sufficient antiarrhythmic drug therapy regarding rhythm control of atrial fibrillation
- •Medical conditions limiting the expected survival to < 1 year
- •On the waiting list for heart transplant.
- •Participation in any other randomized controlled trial
- •Women of childbearing potential without appropriate contraceptive measures (oral contraceptives, vaginal ring, intrauterine devices, implanon, injections, partner with vasectomy)
- •Subjects under legal supervision or guardianship
- •Unable to give informed consent
结局指标
主要结局
VT recurrence
时间窗: 12 months
Time to VT-recurrence based ICD Recordings in dependence of the Mapping modality: Multielectrodemapping with Pentaray/Octaray (Biosense webster) or conventional Point-by-Point mapping with QDOT (Biosense webster)
次要结局
- VT Burden(12 months)
- Comparison of intraprocedural data(directly after procedure)
- Rate of ICD shocks/therapies in the follow up period(12 months)