VINTAGE (Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms) Using Commercial Off-The-Shelf (COTS) Catheters

Ventricular arrhythmias cause heart damage or death. Ventricular arrhythmias usually arise from small zones of the heart that contribute a short circuit or errant stimulus. Ventricular arrhythmias may be reduced or abolished by non-surgical catheter procedures to heat and destroy the small portions of the heart that contribute a short circuit or abnormal pacemaker. However, not all portions of the heart can physically be reached for catheter treatment.

We have developed a new non-surgical catheter approach called VINTAGE (Ventricular Intramyocardial Navigation for Tachycardia Ablation Guided by Electrograms) to treat ventricular arrhythmias arising from difficult-to-reach portions of the heart. In VINTAGE, catheter tools are moved inside the walls of the beating heart to reach treatment targets. In a small number of patients who failed prior catheter treatment of ventricular arrhythmia, VINTAGE effectively suppressed the ventricular arrhythmia or abnormal pacemaker in most.

The purpose of this research protocol is to test VINTAGE more carefully in people with ventricular arrhythmias who have failed prior catheter ablation. In this protocol, we will use catheter tools that are commercially available but are not designed or approved for use in VINTAGE.

• INCLUSION CRITERIA:

Candidates must meet all of the following criteria:

• Age >= 21 years
• Undergoing planned repeat radiofrequency catheter ablation for ventricular arrhythmias (Having failed a previous attempt at catheter ablation and at least one antiarrhythmic drug for ventricular arrhythmias)
• Ventricular arrhythmia COHORT 1:

• Monomorphic ventricular tachycardia
• Has an implanted cardioverter defibrillator (ICD)
• Hospital admission for ventricular tachycardia since most recent ablation attempt
• Ventricular arrhythmia COHORT 2:

--Monomorphic (unifocal), frequent, premature ventricular contraction, >=15% burden

• Either of

• Symptomatic (intolerable palpitation, syncope, fatigue, dyspnea, heart failure, hospital admission for ventricular arrhythmia, appropriate ICD discharge, appropriate antitachycardia pacing), OR
• Left ventricular ejection fraction < 0.50
• Willing to return for all scheduled follow-up activities, and eligible or able to undergo required protocol and testing

Exclusion criteria

• Does not consent to participate, or unable to consent to participate
• Left ventricular ejection fraction < 0.20
• Hemodynamic instability or emergency procedure
• Requires planned temporary mechanical circulatory device (such as percutaneous left ventricular assist device or intraaortic balloon counterpulsation pump)
• Pregnant
• eGFR < 30 mL/min/1.73m^2 or end-stage renal failure requiring renal replacement therapy
• Survival despite successful procedure expected < 6 mo