ANCILLARY STUDY OF SUBSTRATE AND INTERVENTION MECHANISMS FOR MALIGNANT ARRHYTHMIA

恶性心律失常的底物及干预机制的辅助研究

• 批准号: 8714041
• 负责人: Saman Nazarian
• 金额: $ 29.39万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-08-05 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8714041
• 关键词: Ablation; Address; Adrenergic beta-Antagonists; Affect; Anatomy; Ancillary Study; Anti-Arrhythmia Agents; Arrhythmia; Biometry; Cardiac; Cardiac ablation; Characteristics; Cicatrix; Clinical Trials Design; Complication; Data; Defibrillators; Disease Progression; EFRAC; Enrollment; Epidemiology; Evaluation; Exhibits; Goals; Heart Diseases; Heart failure; Image; Imaging Techniques; Implant; Implantable Defibrillators; Infarction; Intervention; Left Ventricular Ejection Fraction; Life; Malignant - descriptor; Measures; Modality; Multicenter Studies; Myocardial; Myocardial Infarction; Myocardium; Participant; Patients; Perfusion; Pharmacotherapy; Property; Randomized; Randomized Clinical Trials; Relative (related person); Rest; Sampling; Shock; Site; Specificity; Testing; Time; Ventricular Tachycardia; X-Ray Computed Tomography; cardiovascular imaging; density; follow-up; heart preservation; implantation; improved; public health relevance; response; success

DESCRIPTION (provided by applicant): Life-threatening ventricular tachycardia (VT) remains a major complication of myocardial infarction. The VT substrate is diseased myocardium that slows local conduction sufficiently to perpetuate circuit reentry. This proposal aims to enhance our understanding of the anatomic details of the VT substrate and its effects upon patient response to antiarrhythmic drug therapy and catheter ablation, an alternative mode of therapy that aims to destroy the VT substrate. Currently, ablation is performed by use of local, point-by-point acquired, intra- cardiac electrograms, which serve as surrogates for each patient's unique VT substrate. This strategy is limited by low sampling density and lack of specificity. Direct evaluation of the anatomic VT substrate has recently become feasible with imaging techniques such as computed tomography (CT). We propose a time-sensitive ancillary study to the "Ventricular Tachycardia Ablation vs. Enhanced Drug Therapy In Structural Heart Disease" (VANISH) and the "Early Ablation Therapy for the Treatment of Ischemic Ventricular Tachycardia in Patients with Implantable Cardioverter Defibrillators" (ASPIRE) multicenter randomized clinical trials. We will acquire resting myocardial CT perfusion and delayed contrast-enhanced CT infarct imaging in 200 VANISH and ASPIRE participants prior to randomization, and at 1-year follow-up. The data will be used to a) define anatomic features that predict the optimal mode of VT therapy thereby allowing proper selection of ablation versus antiarrhythmic drugs, b) define the anatomic details of slow conduction VT substrates, c) determine the substrate changes necessary for VT suppression, and d) characterize the resultant cardiac remodeling from ablation versus drug therapy. We have assembled a team of experts in CT image acquisition and analysis, epidemiology, biostatistics, and VT management. The findings of this study will have wide applicability to optimization of management strategies for patients with post-infarct VT.

描述（由申请人提供）：危及生命的室性心动过速（VT）仍然是心肌梗死的主要并发症。VT底物是病变心肌，足以减缓局部传导，使电路再入永久存在。这一建议旨在加强我们对VT底物的解剖细节及其对患者抗心律失常药物治疗和导管消融反应的影响的理解，导管消融是一种旨在破坏VT底物的替代治疗模式。目前，消融是通过使用局部、逐点获取的心内心电图来进行的，该心电图可作为每个患者独特的VT底物的替代品。这种策略受到采样密度低和缺乏特异性的限制。最近，通过计算机断层扫描（CT）等成像技术，解剖性VT基底的直接评估变得可行。我们建议对“结构性心脏病室性心动过速消融与强化药物治疗”（VANISH）和“植入式心律转复除颤器患者缺血性室性心动过速早期消融治疗”（ASPIRE）多中心随机临床试验进行一项时间敏感的辅助研究。我们将在随机分组前和1年随访中获取200名VANISH和ASPIRE参与者的静息心肌CT灌注和延迟对比增强CT梗死成像。这些数据将用于a)确定预测室性心动过速治疗最佳模式的解剖特征，从而允许适当选择消融术与抗心律失常药物，b)确定慢传导室性心动过速底物的解剖细节，c)确定室性心动过速抑制所需的底物变化，d)表征消融术与药物治疗导致的心脏重塑。我们汇集了CT图像采集和分析、流行病学、生物统计学和VT管理方面的专家团队。本研究结果将广泛适用于优化梗死后室速患者的治疗策略。