Stepwise Approach To sUbstrate Modification for Ventricular Tachycardia (STRATUM VT)

• Catheter Ablation [ Time Frame: at time of catheter ablation procedure (intraoperative) ] [ Designated as safety issue: Yes ]
  The procedural efficacy as defined as acute success of a standardized step-wise approach for substrate-based catheter ablation of recurrent ventricular tachycardia in patients with coronary artery disease and prior ventricular tachycardia or appropriate therapy. Acute success will be defined as the ability to render VT non-inducible with a standardized complete stimulation protocol. catheter ablation - a medical procedure used to treat some types of arrhythmia
  
  

• ICD Interrogation [ Time Frame: baseline and 6 months follow-up ] [ Designated as safety issue: No ]
  Chronic success will be defined as no recurrence of sustained VT or VT resulting in ICD therapies (ATP and/or ICD shocks) at 6 months follow-up as compared to baseline.
  
  
• Procedural Safety [ Time Frame: 1 week post-op ] [ Designated as safety issue: Yes ]
  2) Procedural safety as defined by the number of complication within 1week associated with the procedure.
  
  
• Signal-Average ECG [ Time Frame: baseline and post-op day one after procedure ] [ Designated as safety issue: No ]
  Relationship between change in pre/post saECG and success of the step-wise ablation strategy
  
  

Sudden cardiac death due to VT (ventricular tachycardia) or VF (ventricular fibrillation) occurs at an estimated rate of 300,000 events per year in United States, accounting for 5.6% of annual mortality22. A significant proportion of patients treated with ICDs (implantable defibrillators) will receive shocks due to recurrent VT, resulting in increased mortality8. As a result, catheter-based ablation has emerged as an effective treatment for recurrent VT. However, no study has assessed the impact of a step-wise approach on the outcome of catheter ablation of VT. The investigators propose a prospective, multicenter, non-randomized, single-arm trial to evaluate the impact of a step-wise approach to catheter ablation on ventricular tachycardia recurrence. Given the increasing use of catheter ablation in patients with recurrent ventricular tachycardia, this study will answer a critical question regarding the impact of a step-wise approach on the inducibility of VT at the end of the procedure and clinical recurrences of ventricular arrhythmias at 6 months.