- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04747353
Computed Tomography Targets for Efficient Guidance of Catheter Ablation in Ventricular Tachycardia (MAP-IN-HEART) (MAP-IN-HEART)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Background: Although catheter ablation is a recommended therapeutic option in patients with history of myocardial infarction presenting with sustained ventricular tachycardia (VT),1 the current approach relies on lengthy, poorly reproducible and poorly standardized identification of targets derived from invasive catheter measurements. As a consequence, the rate of VT recurrence remains high, leading to repeat interventions.2 Pre-operative CT scan imaging was shown able to identify arrhythmogenic sites within scar through a detailed analysis of left ventricular (LV) wall thickness.3,4 This study aims at demonstrating that using these as primary targets for ablation is a feasible strategy associated with favorable efficacy, efficiency and safety profiles.
Methods: 40 patients with post-infarction VT referred for catheter ablation will be included over 3 European centres. Pre-operative CT scan will be processed to obtain a 3D model of the patient heart comprising detailed anatomy and LV wall thickness maps. Channels of relatively preserved thickness penetrating within severely thinned scar (i.e. CT-channels) will be identified using a proprietary algorithm developed at the IHU LIRYC, University of Bordeaux, and used as primary targets for catheter ablation. During the intervention, the 3D model along with pre-operatively defined targets will be registered in the 3D mapping space, and each CT-channel will be transected by ablation. The inducibility of VT will then be tested and any VT remaining inducible after CT-channels ablation will be targeted using conventional catheter mapping techniques, with a composite procedural endpoint combining the ablation of all CT channels and the non-inducibility of any VT. Procedural and 6-month follow-up data will be analyzed to assess the feasibility of the approach and report its efficiency, efficacy and safety profiles.
Expected results: the CT-guided ablation strategy is expected to be feasible in a vast majority of post-infarction patients referred for VT ablation, and to be extremely time-efficient, the lengthy diagnostic part of the procedure (catheter mapping) being moved pre-operatively (imaging). The short procedure duration should translate into a favorable safety profile. The strategy should also be associated with a high efficacy in eliminating the arrhythmia, thanks to a more comprehensive definition of targets and to the dedication of the procedure time almost entirely to therapy. In conclusion, the present study should provide solid proof of concept on which randomized controlled trials may be built.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Pessac, France
- Department of Cardiac Pacing and Electrophysiology, CHU Bordeaux
-
-
-
-
-
Lucerne, Switzerland
- Heart Centre, Luzerner Kantonsspital
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years
- Indication for catheter ablation intervention with planned preoperative cardiac CT scan
- Prior myocardial infarction (using the international definition of MI: Q waves or imaging evidence of regional myocardial akinesis/thinning in the absence of a non- ischemic cause with documentation of prior ischemic injury)
and
One of the following monomorphic VT events within last 6 months:
- A: ≥3 episodes of symptomatic VT treated with antitachycardia pacing (ATP),
- B: ≥1 appropriate ICD shocks,
- C: ≥3 VT episodes within 24 hr
- D: sustained VT below detection rate of the ICD documented by ECG or any cardiac monitor
- E: Sustained VT recorded on 12 leads ECG in the absence of ICD
- Signed informed consent
- Affiliated or beneficiary of health insurance
Exclusion Criteria:
- Unable or unwilling to provide written informed consent.
- Active ischemia (acute thrombus diagnosed by coronary angiography, or dynamic ST segment changes demonstrated on ECG) or another reversible cause of VT (e.g. drug-induced arrhythmia), had recent acute coronary syndrome within 30 days thought to be due to acute coronary arterial thrombosis, or have CCS functional class IV angina. Note that biomarker level elevation alone after ventricular arrhythmias does not denote acute coronary syndrome or active ischemia.
- Are known to have protruding left ventricular thrombus or mechanical aortic and mitral valves.
- Have had a prior catheter ablation procedure for VT
- Presenting arrhythmia: polymorphic VT or ventricular fibrillation (VF).
- Are in renal failure (Creatinine clearance <30 mL/min), have NYHA Functional class IV heart failure, or a systemic illness likely to limit survival to <1 year.
Pregnancy, breast feeding women and women who are of childbearing age and not practicing adequate birth control. (French HAS criteria or following methods are considered adequate):
- Combined hormonal contraception
- Injected hormonal contraception
- Implanted hormonal contraception
- Progesterone-only hormonal contraception associated with inhibition of ovulation
- Placement of an intrauterine device (IUD)
- Placement of intrauterine hormone-realising system (IUS)
- Patient under legal protection.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Catheter ablation procedure with heart 3D model
Experimental: Catheter ablation procedure performed as part of standard care, although with the addition of an image-based 3D heart model including detailed anatomy and primary ablation targets
|
Device: Catheter ablation procedure performed as part of standard care, although with the addition of an image-based 3D heart model including detailed anatomy and primary ablation targets
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
evaluation of image-guided VT ablation protocol
Time Frame: end of catheter ablation procedure (hour 3)
|
Feasibility of the image-guided VT ablation protocol, defined by the presence of all following criteria:
|
end of catheter ablation procedure (hour 3)
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Rate of acute success after CT-channels ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Rate of acute success after CT-channels ablation, defined as non-inducibility of any VT using a prescribed programmed ventricular stimulation protocol.
|
end of catheter ablation procedure (hour 3)
|
Number of VTs persisting after CT channel ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Number of VTs persisting after CT channel ablation
|
end of catheter ablation procedure (hour 3)
|
Cycle lengths of VTs persisting after CT channel ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Cycle lengths of VTs persisting after CT channel ablation (ms)
|
end of catheter ablation procedure (hour 3)
|
Location of VTs persisting after CT channel ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Location of VTs persisting after CT channel ablation with respect to CT channels.
Location (critical isthmuses) will be identified using conventional pace mapping or VT/entrainment mapping methods, and described as matching or not matching the location of one CT channel (yes/no/NA)
|
end of catheter ablation procedure (hour 3)
|
Rate of acute success at the end of the procedure
Time Frame: end of catheter ablation procedure (hour 3)
|
Rate of acute success at the end of the procedure, i.e. after CT-channels ablation and targeting of the potential remaining VTs, defined as non-inducibility of any VT using a prescribed programmed ventricular stimulation protocol.
|
end of catheter ablation procedure (hour 3)
|
Number of VTs persisting at the end of the procedure
Time Frame: end of catheter ablation procedure (hour 3)
|
Number of VTs persisting at the end of the procedure
|
end of catheter ablation procedure (hour 3)
|
Cycle lengths of VTs persisting at the end of the procedure
Time Frame: end of catheter ablation procedure (hour 3)
|
Cycle lengths of VTs persisting at the end of the procedure (ms)
|
end of catheter ablation procedure (hour 3)
|
Location of VTs persisting at the end of the procedure
Time Frame: end of catheter ablation procedure (hour 3
|
Location of VTs persisting at the end of the procedure with respect to CT channels.
Location (critical isthmuses) will be identified using conventional pace mapping or VT/entrainment mapping methods, and described as matching or not matching the location of one CT channel (yes/no/NA)
|
end of catheter ablation procedure (hour 3
|
Rate of VT recurrence at 6-month follow-up
Time Frame: Month 6
|
Rate of VT recurrence at 6-month follow-up, defined as at least one appropriate ICD therapy (antitachycardia pacing or shock).
|
Month 6
|
number of sustained VT episodes
Time Frame: Baseline, Month 6
|
Efficacy in reducing VT burden, defined as the number of sustained VT episodes detected by the ICD in the 6 months before vs. 6 months after image-guided VT ablation.
|
Baseline, Month 6
|
Mortality at 6 months follow-up
Time Frame: Month 6
|
Mortality at 6 months follow-up
|
Month 6
|
Total procedure duration
Time Frame: end of catheter ablation procedure (hour 3)
|
Total procedure duration, defined as the total skin-to-skin time
|
end of catheter ablation procedure (hour 3)
|
Procedure duration from start to first radiofrequency ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Procedure duration from start to first radiofrequency ablation
|
end of catheter ablation procedure (hour 3)
|
Total radiofrequency ablation time.
Time Frame: end of catheter ablation procedure (hour 3)
|
Total radiofrequency ablation time.
|
end of catheter ablation procedure (hour 3)
|
Procedure duration from start to completion of CT channels ablation
Time Frame: end of catheter ablation procedure (hour 3)
|
Procedure duration from start to completion of CT channels ablation.
|
end of catheter ablation procedure (hour 3)
|
Serious adverse effects
Time Frame: Baseline, Month 6
|
Major procedure-related complications, including any complication that is potentially life-threatening or that prolongs hospitalization
|
Baseline, Month 6
|
Collaborators and Investigators
Sponsor
Collaborators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- CHUBX 2021/01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Ventricular Tachycardia
-
University of PretoriaCompletedSupra-ventricular TachycardiaSouth Africa
-
Ottawa Heart Institute Research CorporationNot yet recruitingVentricular Fibrillation | Ventricular Tachycardia | Ventricular Arrhythmias | Recurrent Ventricular Tachycardia
-
Armgo Pharma, Inc.Food and Drug Administration (FDA)RecruitingCatecholaminergic Polymorphic Ventricular Tachycardia Type 1United States, Netherlands
-
University of Turin, ItalyAzienda Unità Sanitaria Locale Reggio Emilia; IRCCS Sacro Cuore Don Calabria... and other collaboratorsRecruitingRefractory Ventricular TachycardiaItaly
-
Thermedical, Inc.Not yet recruitingRefractory Ventricular TachycardiaUnited States, Canada
-
John SappCompleted
-
University of California, Los AngelesCompletedRefractory Ventricular TachycardiaUnited States
-
Hospital General Universitario Gregorio MarañonCompletedMonomorphic Ventricular TachycardiaSpain
-
Abbott Medical DevicesTerminatedMonomorphic Ventricular TachycardiaUnited States, United Kingdom, France, Australia, Italy
-
Abbott Medical DevicesWithdrawn
Clinical Trials on Catheter ablation procedure with heart 3D model
-
Children's National Research InstituteChildren's Hospital of Philadelphia; Phoenix Children's HospitalWithdrawnTransposition of the Great Arteries | Double Outlet Right Ventricle | Truncus Arteriosus | Congenitally Corrected Transposition of the Great ArteriesUnited States
-
Columbia UniversityRecruitingCongenital Heart DiseaseUnited States, Colombia
-
Yeditepe UniversityNot yet recruitingCongenital Heart DiseaseTurkey
-
University of California, San FranciscoCompletedNeurocognitive DysfunctionUnited States, Canada
-
AtriCure, Inc.CompletedAtrial FibrillationUnited States, Netherlands, Belgium
-
Medical University of LublinUnknownArrhythmias, Cardiac | Arrhythmia | Ventricular Arrythmia | Atrial ArrhythmiaPoland
-
Biosense Webster, Inc.CompletedArrhythmiasCzech Republic, Belgium
-
University of Sao Paulo General HospitalBiosense Webster, Inc.RecruitingBrugada SyndromeBrazil
-
Klinikum-FuerthKlinikum NürnbergRecruitingSurgery--Complications | Anesthesia Complication | Cardiac Pacemaker Malfunction | ICD Malfunction | Cardiac Pacemaker Electrical InterferenceGermany
-
St. George's Hospital, LondonRecruitingAtrial Fibrillation | Atrial Fibrillation, Persistent | Persistent Atrial Fibrillation | Atrial ArrhythmiaUnited Kingdom