Ventricular Tachycardia in Ischemic Cardiomyopathy; a Combined Endo-Epicardial Ablation Within the First procedure Versus a Stepwise Approach
a randomized controlled trial

Nowadays VT ablation in structural heart disease is performed primarily by
early referral; while at the same time we still struggle with the limited
longterm ablation success of endocardial VT ablation. An underestimated number
of VTs from ischemic substrate have an epicardial exit. However, one cannot
accurately predict who is in need of epicardial ablation. We hypothesise
endo/epicardial substrate homogenization in a first approach to be superior to
endocardial substrate homogenization alone, in terms of recurrence on
follow-up.

To show superiority of a combined endo/epicardial approach compared to a
stepwise approach in the ablation of ventricular tachycardia in a population
with ischemic cardiomyopathy on VT recurrence.

Multicenter prospective open randomized controlled trial.

Combined endo/epicardial substrate homogenization in a first approach

There will be few additional discomforts related to the study for patients
participating in this study. All treatment arms are part of current treatment
practice. Risk associated with epicardial VT ablation is acceptably low and
physical discomfort associated with pericardial access is generally mild and
self-limiting. There is a low risk of tamponade and perforation of surrounding
tissue. Subjects participating in the study will possibly have less recurrence
of VT and subsequently a lower incidence of ICD therapy. There will be no
additional burden on follow-up, where the frequency of ICD interrogation in
this population is as clinically indicated.