search
Back to results

Preventive VT Substrate Ablation in Ischemic Heart Disease (PREVENT-VT)

Primary Purpose

Ventricular Tachycardia, Ventricular Arrythmia, Sudden Cardiac Death

Status
Recruiting
Phase
Phase 3
Locations
Spain
Study Type
Interventional
Intervention
Ventricular tachycardia substrate-based radiofrequency ablation
Sponsored by
Centro Medico Teknon
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Ventricular Tachycardia focused on measuring ventricular tachycardia, ventricular arrhythmia, sudden cardiac death, ischemic heart disease, cardiac magnetic resonance, border zone channels

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age > 18 years.
  • Chronic, stable ischemic heart disease, irrespectively of the LVEF.
  • Life expectancy of > 1 year with a good functional status.
  • Documented scar AND a BZC mass > 5.15 g as measured per LGE-CMR and automatic post-processing using the ADAS-3D LV (ADAS 3D Medical SL, Barcelona, Spain).
  • Signed informed consent.

Exclusion Criteria:

  • Age < 18 years.
  • Pregnancy.
  • Life expectancy of < 1 year, or bad functional status (NYHA IV functional class).
  • Other concomitant structural heart diseases (e.g. congenital, non-ischemic, etc.)
  • Previously documented sustained ventricular arrhythmias.
  • Impossibility to perform a contrast-enhanced CMR study.
  • Calculated BZC mass in the scarred tissue < 5.15 g using the ADAS-3D LV software.
  • Concomitant investigation treatments.
  • Medical, geographical and social factors that make study participation impractical, and inability to give written informed consent. Patient's refusal to participate in the study.

Sites / Locations

  • Centro Medico TeknonRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

ABLATE arm

NO-TREAT arm

Arm Description

Ventricular tachycardia substrate ablation intending to: i) eliminate all the potential arrhythmogenic substrate, aiming for complete electrical isolation/elimination of all the electrograms with delayed components or showing hidden slow conduction properties, and ii) non-inducibility or ventricular tachycardias at the end of the procedure. Standard medical treatment will also be given for these patients.

Only standard medical treatment will be offered for these patients.

Outcomes

Primary Outcome Measures

Rate of sudden cardiac death or sustained ventricular tachycardia
Composite outcome of sudden cardiac death or sustained ventricular tachycardia (either treated by an ICD or documented with continuous Holter monitoring) in patients undergoing preventive ventricular tachycardia (VT) substrate ablation vs. standard of care.

Secondary Outcome Measures

Procedure time
Procedure time
Radiofrequency time
Radiofrequency time
Rate of achievement of complete substrate ablation
Rate of achievement of complete substrate ablation
VT inducibility rate
Final VT inducibility rate
Rate of complications
Rate of complications
Rate of need for anti-arrhythmic drugs
Rate of need for anti-arrhythmic drugs in both arms of the study

Full Information

First Posted
November 29, 2020
Last Updated
August 29, 2023
Sponsor
Centro Medico Teknon
search

1. Study Identification

Unique Protocol Identification Number
NCT04675073
Brief Title
Preventive VT Substrate Ablation in Ischemic Heart Disease
Acronym
PREVENT-VT
Official Title
Preventive VT Substrate Ablation in Patients With Chronic Post-MI Scar Showing Arrhythmogenic Characteristics
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2021 (Actual)
Primary Completion Date
June 2025 (Anticipated)
Study Completion Date
December 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Centro Medico Teknon

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The investigators hypothesize that preventive VT substrate ablation in patients with chronic ICM, previously selected based on imaging criteria (BZC mass) for their likely high arrhythmic risk, is safe and effective in preventing clinical VT events.
Detailed Description
Fibrotic tissue is known to be the substrate for the appearance of scar-related reentrant ventricular arrhythmias (VA) in chronic ischemic cardiomyopathy (ICM). Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has proven to be a useful technique in the non-invasive characterization of the scarred tissue and the underlying arrhythmogenic substrate. Previous studies identified the presence of significant scarring (>5% of the LV mass) is an independent predictor of adverse outcome (all-cause mortality or appropriate ICD discharge for ventricular tachycardia or fibrillation) in patients being considered for implantable cardioverter-defibrillator (ICD) placement. Parallelly, the presence of heterogeneous tissue channels, which correlate with voltage channels after endocardial voltage mapping of the scar, can be more frequently observed in patients suffering from SMVT than in matched controls for age, sex, infarct location, and LVEF. However, the lack of solid evidence and randomized trials make LVEF still the main decision parameter when assessing suitability for ICD implantation in primary prevention of SCD. (7,8) In a recent, case-control study, the investigators identified the BZC mass as the only independent predictor for VT occurrence, after matching for age, sex, LVEF and total scar mass. This BZC mass can be automatically calculated using a commercially available, post-processing imaging platform named ADAS 3D LV (ADAS3D Medical SL, Barcelona, Spain), with FDA 510(k) Clearance and CE Mark approval. Thus, CMR-derived BZC mass might be used as an automatically reproducible criterium to reclassify those patients with chronic ICM at highest risk for developing VA/SCD in a relatively short period of time (approx. 2 years). On the other hand, catheter ablation has become an essential tool in the treatment of ventricular arrhythmias in patients with structural heart disease (SHD). VT ablation techniques have evolved towards substrate-based approaches that permit to abolish multiple VT circuits irrespective of their inducibility or hemodynamic tolerability, improving outcomes with respect to clinical VT ablation. Moreover, VT substrate ablation procedures performed during sinus rhythm and CMR-guided have proven to be safe, with very low procedure related complications. The investigators hypothesize that preventive VT substrate ablation in patients with chronic ICM, previously selected based on imaging criteria (BZC mass) for their likely high arrhythmic risk, is safe and effective in preventing clinical VT events.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Ventricular Tachycardia, Ventricular Arrythmia, Sudden Cardiac Death, Sudden Cardiac Death Due to Cardiac Arrhythmia, Ischemic Heart Disease, Myocardial Infarction, Magnetic Resonance Imaging
Keywords
ventricular tachycardia, ventricular arrhythmia, sudden cardiac death, ischemic heart disease, cardiac magnetic resonance, border zone channels

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
58 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
ABLATE arm
Arm Type
Experimental
Arm Description
Ventricular tachycardia substrate ablation intending to: i) eliminate all the potential arrhythmogenic substrate, aiming for complete electrical isolation/elimination of all the electrograms with delayed components or showing hidden slow conduction properties, and ii) non-inducibility or ventricular tachycardias at the end of the procedure. Standard medical treatment will also be given for these patients.
Arm Title
NO-TREAT arm
Arm Type
No Intervention
Arm Description
Only standard medical treatment will be offered for these patients.
Intervention Type
Procedure
Intervention Name(s)
Ventricular tachycardia substrate-based radiofrequency ablation
Intervention Description
The CARTO3 electroanatomic navigation system (Biosense Webster, Diamond Bar, CA, USA) will be used for ablation. An open irrigated 3.5-mm tip ablation catheter (ThermoCool SmartTouch, Biosense Webster, Diamond Bar, CA, USA) will be used for mapping and ablation. The first step of the procedure will be the acquisition of a fast-anatomical map (FAM) of the aorta. This FAM will be then used to integrate the multi-detector cardiac tomography (MDCT) reconstruction and cardiac magnetic resonance (CMR)-derived pixel-signal intensity (PSI) maps within the spatial reference coordinates of the CARTO3 system. RF will be delivered at the entrance of the border zone channels (BZCs) identified in the PSI maps (CMR-guided scar dechanneling technique). Programmed ventricular stimulation (PVS) will be always performed after substrate elimination to test for final inducibility.
Primary Outcome Measure Information:
Title
Rate of sudden cardiac death or sustained ventricular tachycardia
Description
Composite outcome of sudden cardiac death or sustained ventricular tachycardia (either treated by an ICD or documented with continuous Holter monitoring) in patients undergoing preventive ventricular tachycardia (VT) substrate ablation vs. standard of care.
Time Frame
2 years
Secondary Outcome Measure Information:
Title
Procedure time
Description
Procedure time
Time Frame
2 years
Title
Radiofrequency time
Description
Radiofrequency time
Time Frame
2 years
Title
Rate of achievement of complete substrate ablation
Description
Rate of achievement of complete substrate ablation
Time Frame
2 years
Title
VT inducibility rate
Description
Final VT inducibility rate
Time Frame
2 years
Title
Rate of complications
Description
Rate of complications
Time Frame
2 years
Title
Rate of need for anti-arrhythmic drugs
Description
Rate of need for anti-arrhythmic drugs in both arms of the study
Time Frame
2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age > 18 years. Chronic, stable ischemic heart disease, irrespectively of the LVEF. Life expectancy of > 1 year with a good functional status. Documented scar AND a BZC mass > 5.15 g as measured per LGE-CMR and automatic post-processing using the ADAS-3D LV (ADAS 3D Medical SL, Barcelona, Spain). Signed informed consent. Exclusion Criteria: Age < 18 years. Pregnancy. Life expectancy of < 1 year, or bad functional status (NYHA IV functional class). Other concomitant structural heart diseases (e.g. congenital, non-ischemic, etc.) Previously documented sustained ventricular arrhythmias. Impossibility to perform a contrast-enhanced CMR study. Calculated BZC mass in the scarred tissue < 5.15 g using the ADAS-3D LV software. Concomitant investigation treatments. Medical, geographical and social factors that make study participation impractical, and inability to give written informed consent. Patient's refusal to participate in the study.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Antonio Berruezo, MD, PhD
Phone
(+34) 93 290 62 51
Email
antonio.berruezo@quironsalud.es
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Antonio Berruezo, MD, PhD
Organizational Affiliation
Centro Médico Teknon
Official's Role
Principal Investigator
Facility Information:
Facility Name
Centro Medico Teknon
City
Barcelona
ZIP/Postal Code
08022
Country
Spain
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Antonio Berruezo, MD, PhD
Phone
+34932906200
Email
antonio.berruezo@quironsalud.es
First Name & Middle Initial & Last Name & Degree
Antonio Berruezo, MD, PhD
First Name & Middle Initial & Last Name & Degree
Diego Penela, MD, PhD

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
3342490
Citation
de Bakker JM, van Capelle FJ, Janse MJ, Wilde AA, Coronel R, Becker AE, Dingemans KP, van Hemel NM, Hauer RN. Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation. 1988 Mar;77(3):589-606. doi: 10.1161/01.cir.77.3.589.
Results Reference
background
PubMed Identifier
11197356
Citation
Wu E, Judd RM, Vargas JD, Klocke FJ, Bonow RO, Kim RJ. Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction. Lancet. 2001 Jan 6;357(9249):21-8. doi: 10.1016/S0140-6736(00)03567-4.
Results Reference
background
PubMed Identifier
17389270
Citation
Schmidt A, Azevedo CF, Cheng A, Gupta SN, Bluemke DA, Foo TK, Gerstenblith G, Weiss RG, Marban E, Tomaselli GF, Lima JA, Wu KC. Infarct tissue heterogeneity by magnetic resonance imaging identifies enhanced cardiac arrhythmia susceptibility in patients with left ventricular dysfunction. Circulation. 2007 Apr 17;115(15):2006-14. doi: 10.1161/CIRCULATIONAHA.106.653568. Epub 2007 Mar 26.
Results Reference
background
PubMed Identifier
16801462
Citation
Yan AT, Shayne AJ, Brown KA, Gupta SN, Chan CW, Luu TM, Di Carli MF, Reynolds HG, Stevenson WG, Kwong RY. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006 Jul 4;114(1):32-9. doi: 10.1161/CIRCULATIONAHA.106.613414. Epub 2006 Jun 26.
Results Reference
background
PubMed Identifier
22835669
Citation
Klem I, Weinsaft JW, Bahnson TD, Hegland D, Kim HW, Hayes B, Parker MA, Judd RM, Kim RJ. Assessment of myocardial scarring improves risk stratification in patients evaluated for cardiac defibrillator implantation. J Am Coll Cardiol. 2012 Jul 31;60(5):408-20. doi: 10.1016/j.jacc.2012.02.070.
Results Reference
background
PubMed Identifier
21211689
Citation
Perez-David E, Arenal A, Rubio-Guivernau JL, del Castillo R, Atea L, Arbelo E, Caballero E, Celorrio V, Datino T, Gonzalez-Torrecilla E, Atienza F, Ledesma-Carbayo MJ, Bermejo J, Medina A, Fernandez-Aviles F. Noninvasive identification of ventricular tachycardia-related conducting channels using contrast-enhanced magnetic resonance imaging in patients with chronic myocardial infarction: comparison of signal intensity scar mapping and endocardial voltage mapping. J Am Coll Cardiol. 2011 Jan 11;57(2):184-94. doi: 10.1016/j.jacc.2010.07.043.
Results Reference
background
PubMed Identifier
11907286
Citation
Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002 Mar 21;346(12):877-83. doi: 10.1056/NEJMoa013474. Epub 2002 Mar 19.
Results Reference
background
PubMed Identifier
15659722
Citation
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH; Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005 Jan 20;352(3):225-37. doi: 10.1056/NEJMoa043399. Erratum In: N Engl J Med. 2005 May 19;352(20):2146.
Results Reference
background
PubMed Identifier
27149033
Citation
Sapp JL, Wells GA, Parkash R, Stevenson WG, Blier L, Sarrazin JF, Thibault B, Rivard L, Gula L, Leong-Sit P, Essebag V, Nery PB, Tung SK, Raymond JM, Sterns LD, Veenhuyzen GD, Healey JS, Redfearn D, Roux JF, Tang AS. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med. 2016 Jul 14;375(2):111-21. doi: 10.1056/NEJMoa1513614. Epub 2016 May 5.
Results Reference
background
PubMed Identifier
26718674
Citation
Di Biase L, Burkhardt JD, Lakkireddy D, Carbucicchio C, Mohanty S, Mohanty P, Trivedi C, Santangeli P, Bai R, Forleo G, Horton R, Bailey S, Sanchez J, Al-Ahmad A, Hranitzky P, Gallinghouse GJ, Pelargonio G, Hongo RH, Beheiry S, Hao SC, Reddy M, Rossillo A, Themistoclakis S, Dello Russo A, Casella M, Tondo C, Natale A. Ablation of Stable VTs Versus Substrate Ablation in Ischemic Cardiomyopathy: The VISTA Randomized Multicenter Trial. J Am Coll Cardiol. 2015 Dec 29;66(25):2872-2882. doi: 10.1016/j.jacc.2015.10.026.
Results Reference
background
PubMed Identifier
32327078
Citation
Soto-Iglesias D, Penela D, Jauregui B, Acosta J, Fernandez-Armenta J, Linhart M, Zucchelli G, Syrovnev V, Zaraket F, Teres C, Perea RJ, Prat-Gonzalez S, Doltra A, Ortiz-Perez JT, Bosch X, Camara O, Berruezo A. Cardiac Magnetic Resonance-Guided Ventricular Tachycardia Substrate Ablation. JACC Clin Electrophysiol. 2020 Apr;6(4):436-447. doi: 10.1016/j.jacep.2019.11.004. Epub 2020 Feb 26.
Results Reference
background
PubMed Identifier
33121673
Citation
Fernandez-Armenta J, Soto-Iglesias D, Silva E, Penela D, Jauregui B, Linhart M, Bisbal F, Acosta J, Fernandez M, Borras R, Villuendas R, Cano L, Guasch E, Mont L, Berruezo A. Safety and Outcomes of Ventricular Tachycardia Substrate Ablation During Sinus Rhythm: A Prospective Multicenter Registry. JACC Clin Electrophysiol. 2020 Oct 26;6(11):1435-1448. doi: 10.1016/j.jacep.2020.07.028.
Results Reference
background
PubMed Identifier
31504439
Citation
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, Prescott E, Storey RF, Deaton C, Cuisset T, Agewall S, Dickstein K, Edvardsen T, Escaned J, Gersh BJ, Svitil P, Gilard M, Hasdai D, Hatala R, Mahfoud F, Masip J, Muneretto C, Valgimigli M, Achenbach S, Bax JJ; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020 Jan 14;41(3):407-477. doi: 10.1093/eurheartj/ehz425. No abstract available. Erratum In: Eur Heart J. 2020 Nov 21;41(44):4242.
Results Reference
background
PubMed Identifier
25616406
Citation
Andreu D, Ortiz-Perez JT, Fernandez-Armenta J, Guiu E, Acosta J, Prat-Gonzalez S, De Caralt TM, Perea RJ, Garrido C, Mont L, Brugada J, Berruezo A. 3D delayed-enhanced magnetic resonance sequences improve conducting channel delineation prior to ventricular tachycardia ablation. Europace. 2015 Jun;17(6):938-45. doi: 10.1093/europace/euu310. Epub 2015 Jan 23.
Results Reference
background
PubMed Identifier
21880674
Citation
Andreu D, Berruezo A, Ortiz-Perez JT, Silva E, Mont L, Borras R, de Caralt TM, Perea RJ, Fernandez-Armenta J, Zeljko H, Brugada J. Integration of 3D electroanatomic maps and magnetic resonance scar characterization into the navigation system to guide ventricular tachycardia ablation. Circ Arrhythm Electrophysiol. 2011 Oct;4(5):674-83. doi: 10.1161/CIRCEP.111.961946. Epub 2011 Aug 31.
Results Reference
background
PubMed Identifier
26165946
Citation
Acosta J, Fernandez-Armenta J, Penela D, Andreu D, Borras R, Vassanelli F, Korshunov V, Perea RJ, de Caralt TM, Ortiz JT, Fita G, Sitges M, Brugada J, Mont L, Berruezo A. Infarct transmurality as a criterion for first-line endo-epicardial substrate-guided ventricular tachycardia ablation in ischemic cardiomyopathy. Heart Rhythm. 2016 Jan;13(1):85-95. doi: 10.1016/j.hrthm.2015.07.010. Epub 2015 Jul 9.
Results Reference
background
PubMed Identifier
29427821
Citation
Soto-Iglesias D, Acosta J, Penela D, Fernandez-Armenta J, Cabrera M, Martinez M, Vassanelli F, Alcaine A, Linhart M, Jauregui B, Efimova E, Perea RJ, Prat-Gonzalez S, Ortiz-Perez JT, Bosch X, Mont L, Camara O, Berruezo A. Image-based criteria to identify the presence of epicardial arrhythmogenic substrate in patients with transmural myocardial infarction. Heart Rhythm. 2018 Jun;15(6):814-821. doi: 10.1016/j.hrthm.2018.02.007. Epub 2018 Feb 7.
Results Reference
background
PubMed Identifier
27180621
Citation
Fernandez-Armenta J, Penela D, Acosta J, Andreu D, Evertz R, Cabrera M, Korshunov V, Vassanelli F, Martinez M, Guasch E, Arbelo E, Maria Tolosana J, Mont L, Berruezo A. Substrate modification or ventricular tachycardia induction, mapping, and ablation as the first step? A randomized study. Heart Rhythm. 2016 Aug;13(8):1589-95. doi: 10.1016/j.hrthm.2016.05.013. Epub 2016 May 12.
Results Reference
background
PubMed Identifier
28017938
Citation
Acosta J, Andreu D, Penela D, Cabrera M, Carlosena A, Korshunov V, Vassanelli F, Borras R, Martinez M, Fernandez-Armenta J, Linhart M, Tolosana JM, Mont L, Berruezo A. Elucidation of hidden slow conduction by double ventricular extrastimuli: a method for further arrhythmic substrate identification in ventricular tachycardia ablation procedures. Europace. 2018 Feb 1;20(2):337-346. doi: 10.1093/europace/euw325.
Results Reference
background
PubMed Identifier
25583983
Citation
Berruezo A, Fernandez-Armenta J, Andreu D, Penela D, Herczku C, Evertz R, Cipolletta L, Acosta J, Borras R, Arbelo E, Tolosana JM, Brugada J, Mont L. Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation. Circ Arrhythm Electrophysiol. 2015 Apr;8(2):326-36. doi: 10.1161/CIRCEP.114.002386. Epub 2015 Jan 12.
Results Reference
background
PubMed Identifier
36227461
Citation
Falasconi G, Penela D, Soto-Iglesias D, Francia P, Teres C, Viveros D, Bellido A, Alderete J, Meca-Santamaria J, Franco P, Ordonez A, Diaz-Escofet M, Matiello M, Maldonado G, Scherer C, Huguet M, Camara O, Ortiz-Perez JT, Marti-Almor J, Berruezo A. Preventive substrate ablation in chronic post-myocardial infarction patients with high-risk scar characteristics for ventricular arrhythmias: rationale and design of PREVENT-VT study. J Interv Card Electrophysiol. 2023 Jan;66(1):39-47. doi: 10.1007/s10840-022-01392-w. Epub 2022 Oct 13.
Results Reference
derived

Learn more about this trial

Preventive VT Substrate Ablation in Ischemic Heart Disease

We'll reach out to this number within 24 hrs