comparison of ventricular tachycardia ablation strategies in patients with ischemic cardiomyopathy

Conditions: Ventricular Tachycardia

Summary: this is a prospective multicenter randomized open-label study aiming to assess whether endocardial or endocardial-epicardial ablation is superior to the standard approach (i.e., antiarrhythmic drugs) in achievement of long-term ventricular tachycardia (vt) treatment success.

comparison of ventricular tachycardia ablation strategies in patients with ischemic cardiomyopathy (epi vt) is a prospective multicenter randomized controlled study that is planned as a pilot study to include 100 patients. the aim of our study is to assess whether endocardial or endocardial-epicardial ablation is superior to the standard approach (i.e., antiarrhythmic drugs) in the achievement of long-term ventricular tachycardia (vt) treatment success. patients will be stratified into two groups depending on the history of taking antiarrhythmic medications (aad) and each group will be further randomized 1:1 for endocardial and epicardial ablation vs endocardial only ablation in group who failed aad. and in the group who didn't fail aads patients will be randomized 1:1:1 into 3 groups: endocardial and epicardial ablation, endocardial only ablation or antiarrhythmic medications. follow up planned at 3, 6 and 12 months, if vt recurrence is noted, repeated procedure (according to initially allocated group) or adjustment of medications (if aad group) will be performed. follow up at 3, 6 and 12 months is also planned after a repeat procedure/ medications adjustment. primary endpoints include freedom from documented vt episodes (\> 30 seconds) at 12 months after the first ablation procedure or on antiarrhythmic medication and freedom from documented vt episodes (\>30 seconds) at 12 months after the second ablation procedure or on two antiarrhythmics combined.

Eligibility criteria:
inclusion criteria: * provision of signed and dated informed consent form * stated willingness to comply with all study procedures and availability for the duration of the study * male or female, aged 18 or greater * patient with ≥ 1 episode of vt (i.e., sustained vt more than 30 seconds or vt with any icd therapy) * patients with ischemic cardiomyopathy, ef less than 50%, documented history of cad exclusion criteria: * patients with ventricular fibrillation. * reversible causes of vt. * patients with contraindications to systemic anticoagulation with heparin or coumadin, direct thrombin inhibitor or factor xa inhibitors. * patients with prior procedure involving opening the pericardium or entering the pericardial space (e.g., cabg, heart transplantation, valve surgery) were adhesions are suspected * any prior ablation for the ventricles or any prior epicardial ablation * documented history of myocardial infarction within 1 month prior to the planned study intervention * documented symptomatic carotid disease defined as \> 70% stenosis or \> 50% stenosis with symptoms * any history of thoracic radiation with the exception of localized radiation treatment for breast cancer * active pericarditis * active endocarditis\\any documented history or autoimmune disease associated with pericarditis * thrombocytopenia (platelet count \< 100 x 109/l) * body mass index (bmi \> 45) * patients who are pregnant. 1. pregnancy will be assessed by urine pregnancy testing prior to the ablation procedure

Keywords: ventricular tachycardia catheter ablation epicardial ablation arrhythmia recurrence