Catheter Ablation Versus Anti-arrhythmic Drugs for Ventricular Tachycardia

Launched by WESTERN SYDNEY LOCAL HEALTH DISTRICT · Aug 29, 2022

Keywords

ClinConnect Summary

This clinical trial is studying the effectiveness of catheter ablation (CA) compared to anti-arrhythmic drugs (AADs) for patients with structural heart disease who experience a specific type of irregular heartbeat called ventricular tachycardia (VT). The goal is to see if CA can better reduce the chances of having more VT episodes, severe VT bursts, or even death over an 18-month period. Patients who may be eligible for this study are those aged 18 or older who have had at least one episode of sustained VT in the last six months and already have or will receive a cardiac device like a pacemaker or defibrillator.

If you join this trial, you will be randomly assigned to either receive catheter ablation or continue treatment with anti-arrhythmic medications. The study aims to provide more information on which treatment is more effective for patients with different types of heart disease. Keep in mind that you will need to be able to give informed consent and participate in follow-up visits to track your health during the study. This research is important as it seeks to improve the quality of life for patients dealing with recurrent VT and to find better treatment options.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• Patients will be eligible for inclusion if they have:
• • 1. ≥1 prior episode of sustained VT in the prior 6 months;
• • 1. Spontaneous VT: ≥1 episode of monomorphic VT treated by anti-tachycardia pacing (ATP) and/or internal shock by an ICD; lasting ≥30 seconds in the absence of intra-cardiac device therapy that could either be self-terminating or require reversion by pharmacological therapy or external cardioversion;
• • 2. Spontaneous VT: ≥1 episode of sustained spontaneous monomorphic VT lasting ≥30 seconds documented on Holter, ECG, Loop recorder or other cardiac monitoring device that could either be self-terminating or require reversion by pharmacological therapy or external cardioversion;
• • 3. Inducible VT: with syncope or palpitations - inducible VT defined as sustained monomorphic VT of CL ≥200 ms lasting for ≥10 s during a cardiac electrophysiology study (note with 4 extrastimuli with or without provocation with isoprenaline);
• • 2. Already a recipient of an implanted cardiac device such as a pacemaker, defibrillator or a cardiac resynchronisation therapy device and/or is indicated to receive one given a new diagnosis of structural heart disease, based on current guideline recommendations;
• • 3. Aged ≥18 years.
• Exclusion Criteria:
• Patients will be excluded if they are:
• • 1. Unable or unwilling to provide informed consent or patients physician feels there is not significant equipoise to justify randomisation;
• • 2. Women who are pregnant, breast feeding;
• • 3. Medical illness with an anticipated life expectancy \<3 months;
• • 4. Unable to complete study procedures or unwilling to be followed up;
• • 5. Have a concomitant illness, physical impairment or mental condition which in the opinion of the study team/ primary care physician could interfere with the conduct of the study including outcome assessments;
• • 6. Known channelopathy such as long QT, short QT, Brugada syndrome, catecholaminergic polymorphic VT;
• • 7. Known prior diagnosis of no structural heart disease, or idiopathic ventricular arrhythmia.