Purpose: Patients with ischemic cardiomyopathy (ICM) are prone to scar-related ventricular tachycardia (VT). The success of VT ablation depends on accurate arrhythmogenic substrate localization, followed by optimal delivery of energy provided by constant electrode-tissue contact. Current manual and remote magnetic navigation (RMN)-guided ablation strategies aim to identify a reentry circuit and to target a critical isthmus through activation and entrainment mapping during ongoing tachycardia. The MAGNETIC VT trial will assess if VT ablation using the Niobe™ ES magnetic navigation system results in superior outcomes compared to a manual approach in subjects with ischemic scar VT and low ejection fraction.
Methods and results: This is a randomized, single-blind, prospective, multicenter post-market study. A total of 386 subjects (193 per group) will be enrolled and randomized 1:1 between treatment with the Niobe ES system and treatment via a manual procedure at up to 20 sites. The study population will consist of patients with ischemic cardiomyopathy with left ventricular ejection fraction (LVEF) of ≤35% and implantable cardioverter defibrillator (ICD) who have sustained monomorphic VT. The primary study endpoint is freedom from any recurrence of VT through 12 months. The secondary endpoints are acute success; freedom from any VT at 1 year in a large-scar subpopulation; procedure-related major adverse events; and mortality rate through 12-month follow-up. Follow-up will consist of visits at 3, 6, 9, and 12 months, all of which will include ICD interrogation.
Conclusions: The MAGNETIC VT trial will help determine whether substrate-based ablation of VT with RMN has clinical advantages over manual catheter manipulation. Trial registration: Clinicaltrials.gov identifier: NCT02637947

Additional Metadata
Keywords Atrial fibrillation, Catheter ablation, Heart failure, Ischemic cardiomyopathy, Robotic magnetic navigation, Ventricular tachycardia
Persistent URL dx.doi.org/10.1007/s10840-016-0217-3, hdl.handle.net/1765/95326
Journal Journal of Interventional Cardiac Electrophysiology
Citation
Di Biase, L, Tung, R. (Roderick), Szili-Torok, T, Burkhardt, J.D. (J. David), Weiss, P. (Peter), Tavernier, R, … On Behalf Of Magnetic Vt Investigators,. (2017). MAGNETIC VT study: a prospective, multicenter, post-market randomized controlled trial comparing VT ablation outcomes using remote magnetic navigation-guided substrate mapping and ablation versus manual approach in a low LVEF population. Journal of Interventional Cardiac Electrophysiology, 1–9. doi:10.1007/s10840-016-0217-3