Inducibility and Stability of Ventricular Tachycardia Inpatients Undergoing VT Ablation Under General Anesthesia

Study Overview
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Brief Summary
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This research study is being done to see whether general anesthesia (GA) affects our ability to start ventricular tachycardia (VT) during an VT ablation procedure. Data collected during this research study will help electrophysiologists and anesthesiologists to make the best decisions about the best anesthetic conditions to use to perform VT ablations. This research study is a pilot study. Pilot studies are done on a small group of subjects to learn if a larger study would be useful.

Official Title
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Inducibility and Stability of Ventricular Tachycardia in Patients With Structural Heart Disease Undergoing VT Ablation Under General Anesthesia (Pilot Study)

Conditions
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Ventricular Tachycardia

Intervention / Treatment
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* Drug: Versed
* Drug: Fentanyl
* Drug: Propofol
* Drug: Sevoflurane


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with VT and have an implanted ICD who are scheduled for VT catheter ablation. Patients 18 years of age or older Exclusion Criteria: Patients with difficult airway management or patients with contra/ relative contra indication for general anesthesia or known allergies to any of the proposed anesthetic agents Women who are pregnant

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Anesthesia Induction<br>Patients undergoing ventricular tachycardia ablation will undergo programmed stimulation (PS) with minimal sedation (Versed, Fentanyl), with intravenous agents (propofol) , and finally with volatile inhalational agent (sevoflurane). | Drug: Versed<br>* Phase 1: Standard induction of controled sedation with intravenous agent then programed stimulation to induce ventricular tachycardia<br>* Other names: midazolam;Drug: Fentanyl<br>* Phase 1: Standard induction of controled sedation with intravenous agent then programed stimulation to induce ventricular tachycardia<br>* Other names: Duragesic;Drug: Propofol<br>* Phase 2: Standard induction of GETA with intravenous agent then programed stimulation to induce ventricular tachycardia<br>* Other names: Diprivan;Drug: Sevoflurane<br>* Phase 3: Standard induction of GETA with inhalent agent then programed stimulation to induce ventricular tachycardia<br>* Other names: Ultane;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants Who Had Inducible Ventricular Tachycardia Under General Anesthesia. | Patients before induction of GA undergo noninvasive programmed stimulation (NIPS) using the patient's ICD. Subjects receive minimal versed/fentanyl during the NIPS. The anesthesiologist will decide whether to use propofol prior to the second induction, depending on the patient's cardiac function and hemodynamic status. After induction of GA with IV propofol, programmed stimulation will be performed from the RV catheter. Mapping under volatile agent will commence any time after twice the redistribution half-life of either agent has elapsed (propofol 4-16 mins) or have passed. Once the drug is out of the central compartment it is unlikely to affect myocardial electrolytes or ion channels. GA will be maintained with an inhalation agent, sevoflurane. A repeat programmed stimulation test will be performed. Endpoint for programmed stimulation will be induction of sustained monomorphic VT (SMVT). | While under General Anesthesia, an average of 6 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ventricular tachycardia, ventricular tachycardia ablation, effects of anesthesia on VT induction, programed stimulation