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Targeted Ablation to Isolate Scar Channels Causing Ventricular Tachycardia

8. september 2026 oppdatert av: New York Medical College

Segmental Substrate Isolation for the Treatment of Ventricular Tachycardia in Patients With Structural Heart Disease

The goal of this study is to map conducting channels within scar that cause ventricular tachycardia (VT) in patients with scar in their hearts in order to block these channels from causing VT with targeted radiofrequency ablation (cautery).

Participants undergoing VT ablation mapping of these channels by pacing many sites within the scar area and determining where these channels exit the scar into normal tissue. These exits will be ablated. Immediate success and success at 1 year will be evaluated.

Studieoversikt

Status

Rekruttering

Forhold

Intervensjon / Behandling

Fremgangsmåte: Selective Substrate Isolation

Detaljert beskrivelse

After standard VT induction and mapping procedures (noninvasive identification of induced VT exit sites with Vektor vMap; substrate mapping; initial pacemapping), the study will consist of pacing within the substrate and mapping all channel exits both noninvasively with vMap as well as invasively with high density mapping catheters within the heart by escape mapping (all paced sites creating a consistent paced morphology, up to the shortest stimulus-to-QRS interval achieved) as well as focal activation mapping of this channel exit while pacing within the channel. The noninvasive map will aid in focusing invasive mapping to a small area of the substrate. Once the exit sites are determined, ablation energy will be delivered based on the mapped exit sites in the substrate channel within 0.5cm of the exit with the goal of blocking each exit site mapped. After the ablation lesion set is delivered, repeat attempt to induce VT will be performed. If more VT is induced, additional ablation energy will be delivered guided by standard mapping techniques (substrate, slow conduction zones, pacemapping).

Studietype

Observasjonsmessig

Registrering (Antatt)

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

Forente stater
- New York
  - Valhalla, New York, Forente stater, 10595
    - Rekruttering
    - Westchester Medical Center
    - Underetterforsker:
      
      Daniel Frenkel, MD
    - Ta kontakt med:
      
      Jason T Jacobson, MD
      
      Telefonnummer: 9144935314
      
      E-post: Jason.Jacobson@wmchealth.org
    - Ta kontakt med:
      
      Sei Iwai, MD
      
      Telefonnummer: 9149096900
      
      E-post: Sei.Iwai@wmchealth.org
    - Hovedetterforsker:
      
      Jason Jacobson, MD
    - Underetterforsker:
      
      Sei Iwai, MD

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

Voksen
Eldre voksen

Tar imot friske frivillige

Nei

Prøvetakingsmetode

Ikke-sannsynlighetsprøve

Studiepopulasjon

Patients presenting to Westchester medical Center for ablation of VT with structural heart disease

Beskrivelse

Inclusion Criteria:

Patients with structural heart disease undergoing VT ablation

Exclusion Criteria:

Unable or unwilling to sign consent
Cardiogenic shock or NYHA Class IV heart failure and not a candidate for mechanical circulatory support for the procedure (percutaneous left ventricular assist device (LVAD), extracorporeal membrane oxygenation, or implanted LVAD)
Absence of substrate during initial voltage mapping

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

Hva måler studien?

Primære resultatmål

Resultatmål	Tiltaksbeskrivelse	Tidsramme
Number of participants achieving substrate Isolation with ablation of exit sites Tidsramme: Perioperative/Periprocedural: This will be measured at the end of the study ablation procedure only.	Inability to stimulate the ventricle (physiologic parameter) while pacing in the substrate area contained by the ablation lines through each pacemap exit, at sites that were able to stimulate the ventricle prior to ablation. This will be manifest by the absence of a QRS complex resultant from the pacing stimulus. This is a	Perioperative/Periprocedural: This will be measured at the end of the study ablation procedure only.

Sekundære resultatmål

Resultatmål	Tiltaksbeskrivelse	Tidsramme
VT invasive map exit and vMap exit match Tidsramme: Perioperative/Periprocedural: This will be measured throughout the study ablation procedure.	Percent matching of VT exits determined by activation/entrainment/pace mapping for matched ECG morphologies with vMap determined exits	Perioperative/Periprocedural: This will be measured throughout the study ablation procedure.
Channel exit and vMap match Tidsramme: Perioperative/Periprocedural: This will be measured throughout the study ablation procedure.	Percent matching of noninvasively mapped exit sites compared with invasively mapped channel exits	Perioperative/Periprocedural: This will be measured throughout the study ablation procedure.
Inducibility post initial ablation Tidsramme: Perioperative/Periprocedural: This will be measured during the study ablation procedure, after the first set of radiofrequency lesions is placed based in initial mapping.	VT inducibility after first lesion sets determined by channel mapping	Perioperative/Periprocedural: This will be measured during the study ablation procedure, after the first set of radiofrequency lesions is placed based in initial mapping.
1 year outcome Tidsramme: 1 year: This will be measured for each subject up to 1 year after the study procedure.	VT recurrence at 1 year determined by therapies delivered by implantable cardioverted defibrillator and presentation with sustained VT below ICD detection.	1 year: This will be measured for each subject up to 1 year after the study procedure.

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

New York Medical College

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart (Faktiske)

27. mars 2025

Primær fullføring (Antatt)

9. desember 2027

Studiet fullført (Antatt)

9. desember 2028

Datoer for studieregistrering

Først innsendt

17. juni 2025

Først innsendt som oppfylte QC-kriteriene

8. september 2026

Først lagt ut (Faktiske)

10. september 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)