Ignite Creation Date:
2024-10-25 @ 7:54 PM
Last Modification Date:
2024-10-26 @ 3:39 PM
Study NCT ID:
NCT06575881
Status:
RECRUITING
Last Update Posted:
None
First Post:
2024-08-26
Brief Title:
Defining the Risk of Ventricular Tachycardia in Genetic Cardiomyopathies
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Defining the Risk of Ventricular Tachycardia in Genetic Forms of Early-onset Atrial Fibrillation
Status:
RECRUITING
Status Verified Date:
2024-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
The goal of this observational study is to determine if electrophysiologic mapping and cardiac MRI can help identify patients that have genetic forms of cardiomyopathy that are at high risk for development of dangerous ventricular arrhythmias
The investigators aim to study
1 the prevalence and mechanism of inducible ventricular tachycardia
2 pace-mapping to define the site of origin of ventricular arrhythmias
3 voltage mapping to define low voltage scar substrate in the basal LV to determine the risk of development of ventricular arrhythmias in patients with genetic forms of cardiomyopathy
Participants will undergo cardiac MRI before their scheduled procedure and voltage mapping during their scheduled procedure as part of data collection
The investigators aim to study
1 the prevalence and mechanism of inducible ventricular tachycardia
2 pace-mapping to define the site of origin of ventricular arrhythmias
3 voltage mapping to define low voltage scar substrate in the basal LV to determine the risk of development of ventricular arrhythmias in patients with genetic forms of cardiomyopathy
Participants will undergo cardiac MRI before their scheduled procedure and voltage mapping during their scheduled procedure as part of data collection
Detailed Description:
New genomic knowledge is poised to change clinical practice for atrial fibrillation AF In 1293 cases previously considered idiopathic the investigators identified a pathogenic variant in a cardiomyopathy CM or arrhythmia gene in 11 of patients diagnosed with AF before age 608 and went on to show that these patients have a higher risk of mortality and sudden death The investigators propose tests of specific hypotheses that will address the major knowledge gap of whether and how genetic findings should change clinical management recommendations
Aim To use programmed ventricular stimulation at the time of AF ablation or Electrophysiology Study to define the prevalence and mechanism of inducible ventricular tachycardia VT Aim 1A pace-mapping to define the site of origin of ventricular arrhythmias Aim 1B and voltage mapping to define low voltage scar substrate in the basal LV Aim 1C in patients with pathogenic TTN variants compared to genotype-negative controls
The Aim is informed by the observation that life-threatening VT in patients with dilated CM and pathogenic TTN variants most often localizes to the LV outflow tract LVOT periaortic region and basal septum The investigators found that 39 2770 of patients with early-onset AF and pathogenic TTN variants have premature ventricular contractions PVCs and non-sustained VT that localize to this same area which the investigators therefore hypothesize are an early marker of a malignant arrhythmia substrate Life-threatening ventricular arrhythmias are usually due to scar-related reentry but a major problem with the LVOTperiaortic region is that scar in this area is hard to detect To address this limitation the investigators have published new voltage cutoffs to define scar in the LVOTperiaortic region The Aim addresses the overarching hypothesis that patients with pathogenic TTN variants have occult scar in the basal LV and are at risk for life-threatening reentrant VT The investigators will define the mechanism of VT using a combination of entrainment maneuvers with overdrive pacing and the identification of scar with voltage mapping To facilitate the Aim the investigators have established a dedicated AF Precision Medicine Clinic to evaluate patients with early onset AF Fifty percent of these patients undergo AF ablation for symptomatic AF which the investigators have found is as effective in TTN patients as genotype-negative controls The investigators will enroll 50 patients with a pathogenic variant in TTN 50 with a pathogenic variant in other CM genes eg LMNA and 100 genotype-negative controls
Aim To use programmed ventricular stimulation at the time of AF ablation or Electrophysiology Study to define the prevalence and mechanism of inducible ventricular tachycardia VT Aim 1A pace-mapping to define the site of origin of ventricular arrhythmias Aim 1B and voltage mapping to define low voltage scar substrate in the basal LV Aim 1C in patients with pathogenic TTN variants compared to genotype-negative controls
The Aim is informed by the observation that life-threatening VT in patients with dilated CM and pathogenic TTN variants most often localizes to the LV outflow tract LVOT periaortic region and basal septum The investigators found that 39 2770 of patients with early-onset AF and pathogenic TTN variants have premature ventricular contractions PVCs and non-sustained VT that localize to this same area which the investigators therefore hypothesize are an early marker of a malignant arrhythmia substrate Life-threatening ventricular arrhythmias are usually due to scar-related reentry but a major problem with the LVOTperiaortic region is that scar in this area is hard to detect To address this limitation the investigators have published new voltage cutoffs to define scar in the LVOTperiaortic region The Aim addresses the overarching hypothesis that patients with pathogenic TTN variants have occult scar in the basal LV and are at risk for life-threatening reentrant VT The investigators will define the mechanism of VT using a combination of entrainment maneuvers with overdrive pacing and the identification of scar with voltage mapping To facilitate the Aim the investigators have established a dedicated AF Precision Medicine Clinic to evaluate patients with early onset AF Fifty percent of these patients undergo AF ablation for symptomatic AF which the investigators have found is as effective in TTN patients as genotype-negative controls The investigators will enroll 50 patients with a pathogenic variant in TTN 50 with a pathogenic variant in other CM genes eg LMNA and 100 genotype-negative controls
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None