Preventive substrate ablation in chronic post-myocardial infarction patients with high-risk scar characteristics for ventricular arrhythmias: rationale and design of PREVENT-VT study

• Published in: Journal of interventional cardiac electrophysiology Vol. 66; no. 1; pp. 39 - 47
• Main 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
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2023; Springer Nature B.V
• Subjects: Ablation; Arrhythmia; Arrhythmias, Cardiac - surgery; Cardiology; Catheter Ablation - methods; Cicatrix - diagnostic imaging; Cicatrix - etiology; Cicatrix - surgery; Contrast Media; Death; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Evaluation; Gadolinium; Heart; Heart attacks; Humans; Image enhancement; Magnetic resonance; Medical treatment; Medicine; Medicine & Public Health; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - surgery; Patients; Prevention; Prospective Studies; Safety; Substrates; Tachycardia; Tachycardia, Ventricular - etiology; Tachycardia, Ventricular - prevention & control; Tachycardia, Ventricular - surgery; Ventricle; Ventricular tachycardia; Image-guided ablation; Substrate ablation; Cardiac magnetic resonance
• ISSN: 1572-8595; 1383-875X; 1572-8595
• DOI: 10.1007/s10840-022-01392-w

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.