Sympathetic Nerve Stimulation in Patients with Right Ventricular Outflow Tract Tachycardia

Study Status

Open to Enrollment

Study Description

Abnormal rapid heart rhythms, called tachycardias, occur when the heart beats too fast. A tachycardia may originate in the atria (top chambers), AV node or ventricles (bottom chambers). Ventricular tachycardias in patients with otherwise normal hearts frequently originate from the outlet of the right ventricle. These rapid abnormal heart rhythms are referred to as right ventricular outflow tract tachycardias (RVOT VT), and are thought to be initiated by activation of nerves known as sympathetic nerves that run along a nearby artery within that chamber of the heart called the left pulmonary artery. These nerves are under control of the autonomic nervous system and normally become activated during times of stress or exercise. Recent studies have shown that direct activation of these nerves by electrical stimulation using catheters advanced into the heart and positioned inside the left pulmonary artery can result in abnormal heart rhythms that appear similar to RVOT VT. The purpose of this study is to assess the ability of direct sympathetic nerve stimulation to initiate RVOT VT in patients who have had these specific arrhythmias compared to patients who do not have RVOT-type arrhythmias.

Subjects enrolled in this study have been diagnosed with RVOT or another type of tachycardia and are scheduled for an electrophysiology study (EPS — recording the electrical signals from inside the heart), which involves placing catheters into the heart via the veins of the leg, neck or shoulder. During this routine procedure, patients are given numbing medicine under the skin in these areas prior to insertion of catheters and intravenous medication for relaxation. The doctor advances and positions the catheters inside the heart using x-rays. Once the catheters are in position, a series of electrical impulses is given and multiple recordings of the heart signals are made.

Patients typically receive up to two types of intravenous medications during the procedure. The first type, called a beta-agonist (isoproterenol and/or dobutamine) is used to induce or stimulate the arrhythmia so that the doctor can observe it. The doctor also stimulates the ventricle from different locations to measure the transmission of impulses. Using one additional catheter, the doctor also stimulates the left pulmonary artery to try to induce the RVOT-type arrhythmia. These additional series of paced beats are performed in a fashion similar to that performed during the EPS. If the RVOT arrhythmia can be induced, the doctor gives a second medication called a beta-blocker (esmolol) to stop or slow down the arrhythmia. At the end of the procedure, all catheters are removed from the body. The patient is observed overnight in the hospital with constant monitoring of the heart thythm. The additional measurements taken for this study are expected to add approximately 20 to 30 minutes to the procedure time.

All subjects for this study are scheduled for an EPS due to a tachycardia. Twenty of the 30 patients will have been diagnosed with RVOT and 10 of the 30 will have some other type (non-RVOT) of tachycardia. The second group will serve as the study control.

Continuous 12-lead electrocardiograms are recorded during the study to assess for inducibility of RVOT arrhythmias. The effect of beta-blockade on the inducibility of RVOT arrhythmias will also be assessed.

Sponsor

WCMC Department of Medicine

Key Eligibility

  • Patients undergoing electrophysiology study with or without clinical Right Ventricular Outflow Tachycardia (RVOT) arrhythmias
  • Male or female between the ages of 18 and 70
  • Patient agrees to sign IRB and HIPPA consent forms and to comply with the follow-ups
  • More detailed information is available from study staff.

Principal Investigator

Bruce B. Lerman, MD

Contact

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Contact Us

For general inquiries, or if you need assistance finding a study, please contact:

Robert Hagerty
Subject Recruitment Manager
Tel: (646) 962-9340
[email protected]

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