RIPPLE MAPPING IDENTIFIES ARRHYTHMOGENIC CONDUCTION CHANNELS
Research type
Research Study
Full title
DETERMINING THE PATHOPHYSIOLOGICAL ROLE OF SLOW CONDUCTION CHANNELS IDENTIFIED BY RIPPLE MAPPING OF THE VENTRICULAR SCAR
IRAS ID
143383
Contact name
Prapa Kanagaratnam
Contact email
Research summary
The heart beat is controlled by electrical signals. Following a heart attack, part of the heart muscle dies and is later replaced by scar tissue. Within this area of scar, there often remain “channels” of surviving tissue still able to transmit electrical signals. However, it is well established that these “conduction channels” (CC) can form a short circuit around the scar, leading to electrical disturbances (arrhythmias) that are potentially life threatening. The commonest of these is ventricular tachycardia (VT), and is estimated to cause 300,000 deaths per year.
One recognised treatment option of VT involves burning (ablation) these “conduction channels” (CC) within the scar. However, at present, the procedure is long and is far off 100% effective. Consequently, current best practice does not rely on treating the VT, but rather preventing it from causing sudden death – this is achieved with an Implantable Cardioverter Defibrillator (ICD), a device which can recognise when a patient is in VT and deliver an internal shock to restore the normal electrical conduction. Patients with defibrillators subsequently are subject to recurrent painful and debilitating shocks which, although life-saving, significantly reduce their quality of life.
The limitation with ablation at present is due to the difficulty in visualising these CC’s. We at Imperial College have created a novel visualising program, Ripple Mapping (RM), which we have already found to be superior to currently used programmes in cases of arrhythmias in the upper chambers of the heart (the atria). During a feasibility study of Ripple Mapping in patients with scar following a heart attack, we identified a total of 20 CC’s in 9 patients undergoing an ablation procedure for VT.
We now aim to perform a prospective randomised study comparing a more targeted ablation strategy of CC’s identified using Ripple Mapping against current techniques.
REC name
London - Fulham Research Ethics Committee
REC reference
14/LO/0369
Date of REC Opinion
20 Mar 2014
REC opinion
Favourable Opinion