title: Ventricular tachycardia in ischemic cardiomyopathy; a combined endo-epicardial ablation as the first procedure versus a stepwise approach (EPILOGUE) - study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The role of epicardial substrate ablation of ventricular tachycardia (VT) as a first-line approach in patients with ischemic heart disease is not clearly defined. Epicardial ablation as a first-line option is standard for patients with nonischemic dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Several nonrandomized studies, including studies on patients with ischemic heart disease, have shown that epicardial VT ablation improves outcome but this approach was often used after a failed endocardial approach. The aim of this study is to determine whether a combined endo-epicardial scar homogenization as a first-line approach will improve the outcome of VT ablation.
  
  
  METHODS
  The EPILOGUE study is a multicenter, two-armed, nonblinded, randomized controlled trial. Patients with ischemic heart disease who are referred for VT ablation will be randomly assigned to combined endo-epicardial scar homogenization or endocardial scar homogenization only (control group). The primary outcome is recurrence of sustained VT during a 2-year follow-up. Secondary outcomes include procedural success and safety.
  
  
  CONCLUSIONS
  This study is the first randomized trial that evaluates the role of a combined endo-epicardial scar homogenization versus endocardial scar homogenization for the treatment of ischemic scar-related VT.
  
  
  BACKGROUND
  NL4816807814v02.
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. hendriksastrid@hotmail.com.|Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. hendriksastrid@hotmail.com.
authors.forename: Astrid A
authors.initials: AA
authors.lastname: Hendriks
authors.affiliation: Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. m.khan@olvg.nl.
authors.forename: Muchtiar
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Clinical Electrophysiology, Cardiovascular Center Semmelweis University, Budapest, Hungary. laszlo.geller@gmail.com.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Geller
authors.affiliation: Department of Clinical Electrophysiology, Hungarian National Institute of Cardiology, Budapest, Hungary. drkardosattila@gmail.com.
authors.forename: Attila
authors.initials: A
authors.lastname: Kardos
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. lennartdev@hotmail.com.
authors.forename: Lennart J
authors.initials: LJ
authors.lastname: de Vries
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. s.c.yap@erasmusmc.nl.
authors.forename: Sing-Chien
authors.initials: SC
authors.lastname: Yap
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. s.wijchers@erasmusmc.nl.
authors.forename: Sip A
authors.initials: SA
authors.lastname: Wijchers
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. d.theuns@erasmusmc.nl.
authors.forename: Dominic Amj
authors.initials: DA
authors.lastname: Theuns
authors.affiliation: Department of Clinical Electrophysiology, Erasmus Medical Center, Postbus 2040, 3015, CE, Rotterdam, The Netherlands. t.szilitorok@erasmusmc.nl.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szili-Torok
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002985:Clinical Protocols; D004699:Endocardium / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis; D009426:Netherlands; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012107:Research Design; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome