Feasibility of Contact Force Catheter Mapping and Ablation in Epicardial and Endocardial Ventricular Tachycardias (EPICONTAC-VT)

Study Description

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Brief Summary:

Ventricular tachycardia is one of the commonest cause of sudden death in chronic chagas disease. As most ventricular tachycardias originate from scar in patients with heart disease, catheter ablation is an important step in patient treatment. Identification of fibrosis prior to ablation of sustained ventricular tachycardia (SVT) might reduce the time of anesthesia, procedure time, radiation exposure and possibly the risk of complications. Knowledge of arrhythmia circuit within scar allows planning strategies for each procedure. Condreanu et al. stablished that voltages inferior to 6.52 mV (unipolar) and 1.54mV (bipolar) are useful tools in detecting scar during electroanatomic mapping. Accuracy, however when compared to magnetic resonance imaging is limited due to difficulties in maintaining good contact between ablation catheter and ventricular wall. Contact force catheters might help increase accuracy of voltage mapping because they allow detection of poor contact areas. Although the threshold for identification of scar in ischemic and non ischemic patients during electroanatomical mapping is already known, this parameters still lacking for chronic chagasic individuals. A marked qualitative histological difference between these fibrous scars supports the hypothesis that voltage scar in chagasics might be different. Catheter ablation contact with endo and epicardial surface is an important issue when ablating arrhythmias. Conventional catheter ablation is not equipped with sensors capable of detecting degree of contact with the target. To our knowledge, the literature lacks information in regard to late lesions produced by a known contact force pressure "in vivo". The pattern of electrical activation in these patients and their relationship with local coronary veins for resynchronization likely to approach through the coronary sinus can be useful in defining chagasic that can benefit from resynchronization.

1. Compare endocardial and epicardial impedance and voltage using CARTO 3 with fibrosis on 3T MRI
2. Correlate areas of late activation within scar during activating mapping in sinus rhythm with different signal intensity in 3T MRI
3. Evaluate the influence of contact pressure during application of radiofrequency in making fibrosis analyzed 30 days after the procedure using a 3T MRI.
4. Assess the site of latest left ventricular activation in sinus rhythm and correlate with the coronary veins location

Condition or disease	Intervention/treatment
Ventricular Tachycardia; Sudden Death; Syncope; Chest Pain	Procedure: Catheter ablation

Study Design

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Study Type :	Observational
Estimated Enrollment :	10 participants
Observational Model:	Cohort
Time Perspective:	Prospective
Official Title:	EPIcardial and Endocardial Mapping and Ablation Using Contact Force Catheter in Chagasic Patients With Sustained Ventricular Tachycardia
Study Start Date :	June 2013
Estimated Primary Completion Date :	May 2015
Estimated Study Completion Date :	August 2015

Groups and Cohorts

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Group/Cohort	Intervention/treatment
Catheter ablation; Patients with chronic chagasic disease and documented monomorphic ventricular tachycardia	Procedure: Catheter ablation; During mapping and ablation tissue voltage and impedance will be stored and analyzed thereafter. The same procedure will be done in regard to activating maps.

Outcome Measures

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Evaluate the feasibility of mapping and ablating ventricular tachycardias in endocardial and epicardial using a contact force catheter [ Time Frame: Immediatly after the procedure ]
   The feasibility will be evaluated immediatly after the procedure

Secondary Outcome Measures :

1. Evaluate the impedance and voltage threshold for scar in chronic chagasic cardiomyopathy [ Time Frame: After the procedure ]

Eligibility Criteria

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Ages Eligible for Study:	18 Years to 80 Years (Adult, Senior)
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	No
Sampling Method:	Probability Sample

Study Population

Chagasic patients with symptomatic documented ventricular tachycardia

Criteria

Inclusion Criteria:

• individuals aged between 18 and 80 years old
• life expectancy greater than 1 year
• positive reaction in at least two different serologic techniques for Chagas disease (ELISA, indirect hemagglutination or indirect immunofluorescence)
• symptomatic recurrent monomorphic ventricular tachycardia (recorded by holter, electrocardiogram or looper)
• prior to implantable cardioverter defibrillator implantation in patients with ventricular tachycardia as an attempt to prevent shoks
• patients in "electrical storm", defined as three or more episodes of ventricular tachycardia in 24h. Each episode must demand a medical intervention.
• monomorphic ventricular tachycardia induced during electrical physiological study in patients with syncope of unexplained cause

Exclusion Criteria:

• claustrophobia
• creatinine clearance inferior to 30ml/min/m2 (clearance between 30ml/min/m2 and 60ml/min/m2 will be analyzed individually)
• thrombus in the left ventricle
• pregnancy
• heart failure NYHA IV
• allergy to iodinated contrast or gadolinium
• patients with implantable devices (pacemakers, implantable defibrillators and similar)
• coagulopathy (INR > 1,5 or aPTT 2x normal values)
• platelet count inferior to 100.000

Contacts and Locations

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Contacts

Contact: Lucas H Oliveira, MD	+55(11)99750937 ext 55	lucas.hollanda@unifesp.br
Contact: Enia L Coutinho, Coordinator	+55(11)992914070	coutinho.enia@gmail.com

Locations

Brazil
Federal University of São Paulo, São Paulo Hospital	Recruiting
São Paulo, Brazil, 04024-002
Contact: Enia L Coutinho, coordinator +55(11)992914070 coutinho.enia@gmail.com
Principal Investigator: Lucas H Oliveira, MD
Federal University of São Paulo	Recruiting
São Paulo, Brazil, 04024-002
Contact: Lucas H Oliveira, MD, Msc +55(11)99975-0937 lucas.hollanda@unifesp.br
Sub-Investigator: Angelo AV de Paola, MD, pHD
Sub-Investigator: Claudio Cirenza, MD, pHD
Federal University of São Paulo	Not yet recruiting
São Paulo, Brazil, SP
Contact: Enia L Coutinho, Coordinator +55(11)992914070 coutinho.enia@gmail.com
Principal Investigator: Lucas H Oliveira, MD

Sponsors and Collaborators

Federal University of São Paulo

Investigators

Study Director:	Claudio Cirenza, MD, PhD	Federal University of São Paulo
Study Chair:	Angelo AV de Paola, MD, PhD	Federal University of São Paulo
Principal Investigator:	Lucas H Oliveira, MD	Federal University of São Paulo

More Information

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Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information

Responsible Party:	Lucas Hollanda, MD, Federal University of São Paulo
ClinicalTrials.gov Identifier:	NCT01847378 History of Changes
Other Study ID Numbers:	ISII
First Posted:	May 6, 2013
Last Update Posted:	October 21, 2014
Last Verified:	October 2014

Keywords provided by Lucas Hollanda, Federal University of São Paulo:

ventricular tachycardia; catheter ablation; chagas disease; epicardial mapping; magnetic resonance imaging

Additional relevant MeSH terms:

Tachycardia; Chest Pain; Syncope; Tachycardia, Ventricular; Death, Sudden; Arrhythmias, Cardiac; Heart Diseases; Cardiovascular Diseases; Pathologic Processes	Pain; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Unconsciousness; Consciousness Disorders; Neurobehavioral Manifestations; Death