Ventricular tachycardia ablation guided or aided by scar characterization with cardiac magnetic resonance: rationale and design of VOYAGE study

Alessio Lilli, Matteo Parollo, Lorenzo Mazzocchetti, Francesco De Sensi, Andrea Rossi, Pasquale Notarstefano, Amato Santoro, Giovanni Donato Aquaro, Alberto Cresti, Federica Lapira, Lorenzo Faggioni, Carlo Tessa, Luca Pauselli, Maria Grazia Bongiorni, Antonio Berruezo, Giulio Zucchelli, Alessio Lilli, Matteo Parollo, Lorenzo Mazzocchetti, Francesco De Sensi, Andrea Rossi, Pasquale Notarstefano, Amato Santoro, Giovanni Donato Aquaro, Alberto Cresti, Federica Lapira, Lorenzo Faggioni, Carlo Tessa, Luca Pauselli, Maria Grazia Bongiorni, Antonio Berruezo, Giulio Zucchelli

Abstract

Background: Radiofrequency ablation has been shown to be a safe and effective treatment for scar-related ventricular arrhythmias (VA). Recent preliminary studies have shown that real time integration of late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images with electroanatomical map (EAM) data may lead to increased procedure efficacy, efficiency, and safety.

Methods: VOYAGE is a prospective, randomized, multicenter controlled open label study designed to compare in terms of efficacy, efficiency, and safety a CMR aided/guided workflow to standard EAM-guided ventricular tachycardia (VT) ablation. Patients with an ICD or with ICD implantation expected within 1 month, with scar related VT, suitable for CMR and multidetector computed tomography (MDCT) will be randomized to a CMR-guided or CMR-aided approach, whereas subjects unsuitable for imaging or with image quality deemed not sufficient for postprocessing will be allocated to standard of care ablation. Primary endpoint is defined as VT recurrences (sustained or requiring appropriate ICD intervention) during 12 months follow-up, excluding the first month of blanking period. Secondary endpoints will include procedural efficiency, safety, impact on quality of life and comparison between CMR-guided and CMR-aided approaches. Patients will be evaluated at 1, 6 and 12 months.

Discussion: The clinical impact of real time CMR-guided/aided ablation approaches has not been thoroughly assessed yet. This study aims at defining whether such workflow results in more effective, efficient, and safer procedures. If proven to be of benefit, results from this study could be applied in large scale interventional practice. Trial registrationClinicalTrials.gov, NCT04694079, registered on January 1, 2021.

Keywords: Artificial intelligence; Cardiac magnetic resonance; Image-guided ablation; Structural heart disease; Substrate ablation; Ventricular arrhythmias; Ventricular tachycardia; Ventricular tachycardia ablation.

Conflict of interest statement

AB holds stock in Galgo Medical SL; and has received financial support from Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study design flowchart. VT: ventricular tachycardia; MDCT: multidetector computed tomography; CMR: cardiac magnetic resonance
Fig. 2
Fig. 2
Mapping suite showing a CMR-guided procedure, with VT interruption during RF delivery at an heterogeneous tissue channel (HTC) on 3D CMR model. Green: MDCT-derived aorta 3D model, blue areas: healthy tissue, red areas: scar tissue, yellow areas: border zone

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