Atrial Fibrillation, Ventricular Tachycardia
Conditions
Keywords
catheter ablation, genomics
Brief summary
To use programmed ventricular stimulation at the time of AF ablation to define the prevalence and mechanism of inducible ventricular tachycardia (VT); pace-mapping to define the site of origin of ventricular arrhythmias; and voltage mapping to define low voltage scar substrate in the basal LV in patients with pathogenic TTN variants compared to genotype-negative controls.
Detailed description
Participants will undergo AF ablation according to standard, contemporary techniques. The procedure will be performed under general anesthesia. As part of routine standard of care in patients with early-onset AF or patients who have PVCs, we will also test for inducibility of VT using a standardized pacing protocol. The research protocol will include LV mapping and identification of low voltage substrate using electroanatomical mapping as described below.
Interventions
DIAGNOSTIC_TESTEP Study
To use programmed ventricular stimulation at the time of AF ablation to define the prevalence and mechanism of inducible ventricular tachycardia (VT); pace-mapping to define the site of origin of ventricular arrhythmias; and voltage mapping to define low voltage scar substrate in the basal LV in patients with pathogenic TTN variants compared to genotype-negative controls.
Sponsors
Vanderbilt University Medical Center
Study design
Observational model
CASE_CONTROL
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
1. Adults aged 18 and older 2. Diagnosed with AF before age 60 3. Scheduled for catheter-based AF ablation (de-novo or repeat) 4. Able to provide written, informed consent 5. P/LP variant in TTN or other CM gene (cases) or identified as a genotype-negative control.
Exclusion criteria
1. Diagnosed with a genetic CM or arrhythmia syndrome prior to AF 2. VUS in 'possibly pathogenic' subgroup (control group only) 3. Pacemaker or ICD 4. Previous PVC or VT ablation 5. LVEF \<20% 6. Prosthetic mitral or aortic valve 7. Contraindication to heparin 8. Prior myocardial infarction.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| VT Inducibility | At the time of procedure | The primary endpoint is induction of sustained VT that is determined to be reentrant or likely-reentrant. Sustained VT will be defined as VT lasting 30 seconds or requiring termination with burst pacing or cardioversion due to hemodynamic instability. |
| Presence of ventricular arrhythmias per specific site | At the time of procedure | The primary endpoint is the occurrence (yes/no) of ventricular arrhythmias (PVCs, NSVT, sustained VT) that are mapped to the basal LV as defined above. |
| Low voltage substrate | At the time of procedure | The primary endpoint is the presence of low voltage (yes/no) in the basal LV. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Site of origin for ventricular arrhythmias | At the time of procedure | Secondary analyses will explore the rate of ventricular arrhythmias in other segments of the LV and RV and will compare the site of origin for ventricular arrhythmias in the group of participants with pathogenic variants in other CM genes. |
| Evaluation of electrogram potentials | At the time of procedure | Secondary analyses will explore multicomponent electrograms and fractionated potentials that can be created by scar. |
| Presence of low voltage | At the time of procedure | Other secondary analyses will compare the presence of low voltage and the other secondary endpoints in the group of participants with pathogenic variants in other CM genes. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORMoore B Shoemaker, MD
Vanderbilt University Medical Center
Outcome results
None listed