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- Title
Preventive substrate ablation in chronic post-myocardial infarction patients with high-risk scar characteristics for ventricular arrhythmias: rationale and design of PREVENT-VT study.
- Authors
Falasconi, Giulio; Penela, Diego; Soto-Iglesias, David; Francia, Pietro; Teres, Cheryl; Viveros, Daniel; Bellido, Aldo; Alderete, Jose; Meca-Santamaria, Julia; Franco, Paula; Ordoñez, Augusto; Díaz-Escofet, Marta; Matiello, Maria; Maldonado, Giuliana; Scherer, Claudia; Huguet, Marina; Cámara, Óscar; Ortiz-Pérez, José-Tomás; Martí-Almor, Julio; Berruezo, Antonio
- Abstract
Background: Recent studies showed that an early strategy for ventricular tachycardia (VT) ablation resulted in reduction of VT episodes or mortality. Cardiac magnetic resonance (CMR)-derived border zone channel (BZC) mass has proved to be a strong non-invasive predictor of VT in post-myocardial infarction (MI). CMR-guided VT substrate ablation proved to be safe and effective for reducing sudden cardiac death (SCD) and VA occurrence. Methods: PREVENT-VT is a prospective, randomized, multicenter, and controlled trial designed to evaluate the safety and efficacy of prophylactic CMR-guided VT substrate ablation in chronic post-MI patients with CMR-derived arrhythmogenic scar characteristics. Chronic post-MI patients with late gadolinium enhancement (LGE) CMR will be evaluated. CMR images will be post-processed and the BZC mass measured: patients with a BZC mass > 5.15 g will be eligible. Consecutive patients will be enrolled at 3 centers and randomized on a 1:1 basis to undergo a VT substrate ablation (ABLATE arm) or optimal medical treatment (OMT arm). Primary prevention ICD will be implanted following guideline recommendations, while non-ICD candidates will be implanted with an implantable cardiac monitor (ICM). The primary endpoint is a composite outcome of sudden cardiac death (SCD) or sustained monomorphic VT, either treated by an ICD or documented with ICM. Secondary endpoints are procedural safety and efficiency outcomes of CMR-guided ablation. Discussion: In some patients, the first VA episode causes SCD or severe neurological damage. The aim of the PREVENT-VT is to evaluate whether primary preventive substrate ablation may be a safe and effective prophylactic therapy for reducing SCD and VA occurrence in patients with previous MI and high-risk scar characteristics based on CMR. Trial registration: ClinicalTrials.gov, NCT04675073, registered on January 1, 2021.
- Subjects
HYPERTROPHIC scars; CARDIAC magnetic resonance imaging; VENTRICULAR arrhythmia; MYOCARDIAL infarction; CARDIAC arrest; VENTRICULAR tachycardia; INFARCTION; SCARS
- Publication
Journal of Interventional Cardiac Electrophysiology, 2023, Vol 66, Issue 1, p39
- ISSN
1383-875X
- Publication type
Article
- DOI
10.1007/s10840-022-01392-w