Application of High Power Radio Frequency Energy in the Ventricular Tachycardia Treatment

Application of High Power Radio Frequency Energy in the Interventional Treatment of Patients With Ventricular Tachycardia and Structural Heart Disease

Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Heart and Vascular Center Bad Bevensen, Germany, National Medical Research Center for Cardiology, Ministry of Health of Russian Federation, National Research Center of Surgery, Russia, I.M. Sechenov First Moscow State Medical University, Texas Cardiac Arrhythmia Institute, Austin, Texas

Background: Patient's freedom from VT after RFA remains non-optimal and it depends on many factors. One of them is the effective reduction of the myocardium with RF energy during the operation. The standardization of the parameters of RF will help to increase the success of the procedure. Hypothesis: Radiofrequency ablation of ventricular tachycardias with high power parameters has comparable safety and leads to greater efficacy (absence of ventricular tachycardias and all types of cardioverter-defibrillator therapies) in the long-term compared with ablation with standard parameters in patients with structural heart disease. Purpose: to evaluate the safety and the efficiency of ablation of ventricular tachycardia in patients with structural heart disease using high power RF energy.

Background: Patient's freedom from VT after RFA remains non-optimal and it depends on many factors. One of them is the effective reduction of the myocardium with RF energy during the operation. The standardization of the parameters of RF will help to increase the success of the procedure. Hypothesis: Radiofrequency ablation of ventricular tachycardias with high power parameters has comparable safety and leads to greater efficacy (absence of ventricular tachycardias and all types of cardioverter-defibrillator therapies) in the long-term compared with ablation with standard parameters in patients with structural heart disease. Purpose: to evaluate the safety and the efficiency of ablation of ventricular tachycardia in patients with structural heart disease using high power RF energy. Tasks: To analyze the number of intraoperative complications in both groups To evaluate the number of recurrent ventricular tachycardias and the number of episodes of CDI therapy in the long-term follow-up period To estimate the time of onset of the first episode of VT and the overall burden of VT in the long-term follow-up period To compare the total time of surgery, fluoroscopy, the number and total time of RF exposure, as well as the ablation index in relation to the "acute" and separated efficiency of ablation in the study groups To estimate all-cause mortality in both groups The number of repeated ablation for recurrent VT The number of justified and unfounded CDI therapies To analyze the long-term burden of antiarrhythmic therapy

The number of intraoperative complications (death, hemopericardium, stroke, heart attack, electrical storm, vascular complications)

Inclusion Criteria: Patients after myocardial infarction (at least 3 months before enrollment in the study) Stable, documented, monomorphic VT, confirmed by ECG and / or CMECG and / or EGM of any implanted device, having appropriate rhythm discrimination algorithms Patients who have signed the informed consent Exclusion Criteria: Acute myocardial ischemia A reversible cause of VT (e.g. drug arrhythmia), recently(up to 30 days) suffered from acute coronary syndrome, coronary revascularization (<90 days for bypass surgery, <30 days for percutaneous coronary intervention), or having functional class IV angina. Thrombosis of the left ventricle Patients who have been implanted the mechanical prostheses in the aortic and mitral positions. Patients who have been performed the catheter RFA for VT. Renal failure (creatinine clearance <15 ml / min), Patients with NYHA functional class IV heart failure Patients with a medical condition that may limit survival to less than 1 year Patients with myocardial infarction with ST-segment elevation or MI without ST-segment elevation, transferred less than 30 days ago. Patients who haven't signed the informed consent