Paced Electrogram Feature Analysis (PEFA) for Ablation Targeting in Ischaemic Ventricular Tachycardia
Paced Electrogram Feature Analysis (PEFA) for Ablation Targeting in Ischaemic Ventricular Tachycardia
Canadian multicentre prospective cohort study of 40 patients with ischaemic heart disease and
 therapy from an implantable cardioverter defibrillator (ICD).
Paced Electrogram Feature Analysis is employed to elucidate VT isthmus sites and target Type
 I sites for ablation to prevent recurrent VT/VF.

 The trial hypothesis is: catheter ablation employing PEFA will, in comparison to published
 data, reduce the composite outcome of death at any time, appropriate ICD shock, ventricular
 tachycardia storm or treated sustained ventricular tachycardia below the detection rate of
 the ICD or incessant VT for patients with prior myocardial infarction and sustained
 ventricular tachycardia or fibrillation.
Inclusion Criteria:

 -  greater than 18 years of age

 -  Ischaemic heart disease and prior myocardial infarction (using the international
 definition of MI: Q waves or imaging evidence of regional myocardial akinesis/thinning
 in the absence of a non-ischemic cause with documentation of prior ischaemic injury)

 -  Eligible for catheter ablation as standard of care

 -  Implantable Cardioverter Defibrillator

 Exclusion Criteria:

 -  Unable or unwilling to provide consent

 -  Both mechanical aortic and mitral valve

 -  LV thrombus,

 -  NYHA class IV heart failure symptoms

 -  Contraindication to heparin

 -  Survival limited to <1 year in estimation of attending care team,

 -  Prior VT ablation Exclusion to standard of care VT catheter ablation procedure such as

 -  Active ischaemia (acute thrombus diagnosed by coronary angiography, or dynamic ST
 segment changes demonstrated on ECG) or another reversible cause of VT (e.g. drug-
 induced arrhythmia), had recent acute coronary syndrome within 30 days thought to be
 due to acute coronary arterial thrombosis, or have CCS functional class IV angina.
 Note that biomarker level elevation alone after ventricular arrhythmias does not
 denote acute coronary syndrome or active ischemia.

 -  Non-ischaemic cardiomyopathy because of reduced ablation success and PEFA has not been
 examined in the context of a non-ischaemic cardiomyopathy