Continuation of Antiarrhythmics Following Ventricular Tachycardia Catheter Ablation

Tachycardia, Ventricular Clinical Trial

— AFTER-VT  

Official title:

Continuation of Antiarrhythmics Following caThEteR Ablation for Ventricular Tachycardia (AFTER-VT) Trial: A Pilot Randomized Clinical Trial

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT04208997
• Other study ID #: 191113
• Status: Terminated
• Phase: Phase 3
• Start date: December 19, 2019
• Est. completion date: June 30, 2021

Study information

• Verified date: October 2022
• Source: Vanderbilt University Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The investigators aim to study if patients that undergo catheter ablation for ventricular tachycardia benefit from continuation of Vaughan-Williams class III antiarrhythmic drugs for 3 months after their ablation.

Description:

Catheter ablation is a valuable option to control recurrent Ventricular Tachycardia (VT) in patients with structural heart disease. A recent trial proved that catheter ablation is superior to escalation of anti arrhythmic drugs (AADs) in prevention of VT recurrence and death (Sapp et al. N Engl J Med 2016; 375:111-121). However, even with ablation, approximately 20-50% of patients will have an episode of VT within one year. This is probably explained in part by the substrate (myocardial scar from cardiomyopathy) persists after VT ablation and that ablation lesions heal and evolve over days, weeks and even months. Most patients (if not all) of patients who undergo ablation are on AADs and usually have failed at least one of them. Furthermore, most AADs, and Vaughan Williams class III AADs in particular (the most frequently used to treat VT) carry significant and life-threatening side effects from pulmonary, hepatic and hematologic toxicities up to significant ventricular arrhythmias and death. Since these patients have already failed AADs, and the significant adverse profile of AADs, there is no evidence that the benefits of continuation of these drugs will surpass the risks after ablation. Therefore the investigators decided to ask the question:

Among patients with structural heart disease who undergo VT ablation, does continuation of class III AADs for 3 months, increases VT-free survival compared to discontinuation of antiarrhythmic drug therapy?

Based on expert consensus about clinical equipoise in regards of AAD continuation after VT ablation, the investigators decided to select patients with lowest risk of VT recurrence after ablation as our study population. The investigators aim to include in our study only those patients who have an Implantable Cardioverter-Defibrillator (ICD), who have NO inducible VT at the end of the ablation procedure and also who have NO inducible VT prior to discharge on a procedure called non-invasive programmed stimulation (NIPS). It has been shown that patients with inducible VT at the end of ablation and during NIPS have significantly higher risk of VT recurrence compared to those in whom VT was not induced. In NIPS, one uses the previously Implanted ICD to pace the ventricle fast enough to try to induce VT. Both procedures will be performed as usual practice in patients who undergo VT ablation in the arrhythmia service.

The specific aim of this pilot study is to evaluate whether the strategy of continuation of class III AADs following initial catheter ablation for VT, improves VT-free survival and reduces readmissions.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 5
• Est. completion date: June 30, 2021
• Est. primary completion date: June 30, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Age >18 years.

2. Able to give written, informed consent

3. Structural heart disease.

4. Implanted and normally functioning ICD or undergoing ICD implant at index admission.

5. Undergoing initial radiofrequency ablation procedure for sustained monomorphic VT.

6. Receiving a class III AADs prior to VT ablation.

7. No VT inducible at the end of VT ablation.

8. No VT inducible on non-invasive programmed stimulation following VT ablation.

Exclusion Criteria:

1. LV assist device in place

2. Decompensated heart failure and/or requiring continuous inotropic therapy and/or awaiting cardiac transplantation

3. Ongoing acute coronary syndrome.

4. Mechanical prosthetic aortic and mitral valves.

5. Pedunculated or mobile left ventricular thrombus.

6. Persistent VT at the end of index catheter ablation.

7. Absolute contraindications for class III AADs.

8. Participation in other trial.

9. VT induced on NIPS after VT ablation.

10. Another reason for continuation of class III AADs (i.e., atrial fibrillation).

Related Conditions & MeSH terms

• Catheter Ablation
• Tachycardia
• Tachycardia, Ventricular

Intervention

Drug:
• Antiarrhythmic drug
Continuation of amiodarone or sotalol.

Locations

Country	Name	City	State
United States	Vanderbilt University Medical Center	Nashville	Tennessee

Sponsors (1)

Lead Sponsor	Collaborator
Vanderbilt University Medical Center

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Number of Participants With Drug Side Effects	Side effects attributed to any drug of the patient's regimen	One year after ablation
Primary	Number of Participants Dead or With VT Recurrence at One Year	A composite of all-cause mortality and VT recurrence one year after index VT ablation	One year after ablation
Secondary	All-cause Mortality	Deaths by any cause one year after ablation	One year after ablation
Secondary	Number of Participants With VT Recurrence	Self-terminating sustained VTs (>30 seconds or hemodynamic instability) and VT requiring ICD device therapies for termination (appropriate therapies) will be considered VT recurrences	One year after ablation
Secondary	Number of Participants With VT/Electrical Storm	Three or more episodes of sustained VT, ventricular fibrillation, or appropriate ICD therapies within a 24-hour period	One year after ablation
Secondary	Number of Participants With Readmission for Heart Failure	Admissions with heart failure as principal diagnosis	One year after ablation