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: 9119158
• 负责人: Saman Nazarian
• 金额: $ 28.06万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 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 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9119158
• 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; Health; 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; Rest; Sampling; Selection for Treatments; Shock; Site; Specificity; Testing; Time; Ventricular Tachycardia; X-Ray Computed Tomography; cardiovascular imaging; contrast enhanced; density; follow-up; heart preservation; implantation; improved; response; structural heart disease; 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。室性心动过速的基质是病变的心肌，它使局部传导减慢，足以使回路折返永久化。该提案旨在增强我们对VT基质的解剖细节及其对抗心律失常药物治疗和导管消融（旨在破坏VT基质的替代治疗模式）的患者反应的影响的理解。目前，通过使用局部逐点采集的心内电描记图来执行消融，所述心内电描记图用作每个患者的独特VT基底的替代物。这一战略受到抽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）等成像技术直接评价解剖VT基底已变得可行。我们建议对“结构性心脏病室性心动过速消融与增强药物治疗”（VANISH）和“植入式心律转复除颤器患者缺血性室性心动过速的早期消融治疗”（ASPIRE）多中心随机临床试验进行一项时间敏感的辅助研究。我们将在随机化前和1年随访时对200名VANISH和ASPIRE受试者进行静息心肌CT灌注和延迟对比增强CT梗死成像。数据将用于a）定义预测VT治疗最佳模式的解剖特征，从而允许正确选择消融与抗心律失常药物，B）定义慢传导VT基质的解剖细节，c）确定VT抑制所需的基质变化，以及d）表征消融与药物治疗的心脏重塑。我们已经组建了一个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。这项研究的结果将有广泛的适用性，以优化管理策略的患者梗死后室性心动过速。

项目成果

PRECAF Randomized Controlled Trial.

• DOI: 10.1161/circep.120.008993
• 发表时间: 2021-01
• 期刊: Circulation. Arrhythmia and electrophysiology
• 作者: Kuo L;Frankel DS;Lin A;Arkles J;Hyman M;Santangeli P;Marchlinski FE;Nazarian S
• 通讯作者: Nazarian S

Non-Scar-Related and Purkinje-Related Ventricular Tachycardia in Patients With Structural Heart Disease: Prevalence, Mapping Features, and Clinical Outcomes.

结构性心脏病患者的非疤痕相关和浦肯野相关室性心动过速：患病率、映射特征和临床结果。

• DOI: 10.1016/j.jacep.2019.09.014
• 发表时间: 2020
• 期刊: JACC. Clinical electrophysiology
• 作者: Shirai,Yasuhiro;Liang,JacksonJ;Hirao,Kenzo;Hyman,MatthewC;Kumareswaran,Ramanan;Arkles,JeffreyS;Schaller,RobertD;Supple,GregoryE;Frankel,DavidS;Nazarian,Saman;Riley,MichaelP;Garcia,FerminC;Lin,David;Dixit,Sanjay;Callans,
• 通讯作者: Callans,

Utility of ripple mapping for identification of slow conduction channels during ventricular tachycardia ablation in the setting of arrhythmogenic right ventricular cardiomyopathy.

在致心律失常性右心室心肌病的情况下，在室性心动过速消融过程中使用波纹映射来识别慢传导通道。

• DOI: 10.1111/jce.13819
• 发表时间: 2019
• 期刊: Journal of cardiovascular electrophysiology
• 影响因子: 2.7
• 作者: Xie,Shuanglun;Kubala,Maciej;Liang,JacksonJ;Yang,Jiandu;Desjardins,Benoit;Santangeli,Pasquale;vanderGeest,RobJ;Schaller,Robert;Riley,Michael;Supple,Gregory;Frankel,DavidS;Callans,David;Pac,EricaZado;Marchlinski,Francis;Naz
• 通讯作者: Naz

Association of septal late gadolinium enhancement on cardiac magnetic resonance with ventricular tachycardia ablation targets in nonischemic cardiomyopathy.

心脏磁共振间隔晚期钆增强与非缺血性心肌病室性心动过速消融目标的关联。

• DOI: 10.1111/jce.14777
• 发表时间: 2020
• 期刊: Journal of cardiovascular electrophysiology
• 影响因子: 2.7
• 作者: Kuo,Ling;Liang,JacksonJ;Han,Yuchi;Frankel,DavidS;Santangeli,Pasquale;Callans,DavidJ;Zado,EricaS;Marchlinski,FrancisE;Desjardins,Benoit;Nazarian,Saman
• 通讯作者: Nazarian,Saman

Dechanneling Left Atrial Late Gadolinium Enhancement: An Imaging Moon Shot?

左心房晚期钆去通道增强：成像登月计划？

• DOI: 10.1161/circep.119.007683
• 发表时间: 2019
• 期刊: Circulation. Arrhythmia and electrophysiology
• 作者: Nazarian,Saman;Marchlinski,Francis
• 通讯作者: Marchlinski,Francis