Eliminating Ventricular Tachycardia: Pivotal Clinical Trial using the Durablate® Catheter

Ventricular tachycardia (VT) causes more than half of the 170,000–450,000 sudden cardiac deaths (SCD) that occur annually in the United States. Implantable cardioverter defibrillators (ICDs) are the standard of care, but they are expensive (the total cost of an ICD implant exceeds $50,000) and not curative. Patients who receive ICDs are subject to shocks to halt episodes of VT, and those shocks can be painful and traumatic. RF ablation represents a potential method for curing VT, at a much lower cost than ICDs, but while RF ablation has been successful at treating atrial arrhythmias, it is not as effective at treating VT. An ablation tool capable of treating VT has the potential to improve ICD therapy by eliminating shocks or even the need for ICD implants, greatly reducing the cost to the health care system of treating VT while also improving the lives of patients affected by VT. Recent advances in 3-D reconstruction of CT or MRI images and with merging those images with electroanatomic maps have made identification of the tissue that needs to be ablated easier. We have developed the ablation tool that can reliably treat all VT foci. We have developed the Durablate® Catheter and SERF ablation specifically the treatment of VT. Our technology delivers heated saline along with RF energy and is unique in its ability to treat the large volumes of cardiac tissue necessary to eliminate arrhythmogenic tissue located either on the endocardial surface or deep in the ventricular wall. Our technology can treat much larger volumes of tissue than conventional RF because saline carries the heat generated by RF into tissue by convection. We also have fine control over the size of the ablated lesion since we have control over the amount of saline delivered. SERF lesions can be as small or as large as the physician needs and they will be the size the physician calls for. We have successfully concluded a small first-in-human study whose results were recently published in Circulation: Arrhythmia and Electrophysiology. An accompanying editorial described the results as “impressive” in a patient population with “clinical characteristics that would intimidate even the most optimistic and experienced VT ablation enthusiasts.” The FDA has awarded our technology Breakthrough Device Designation and has approved our IDE for our pivotal clinical trial. We will conduct the 154-patient single-arm study at seven centers. Patients will be eligible for the study if they have recurrent, symptomatic VT; if they have failed prior cardiac catheter VT ablation; if the etiology of the arrhythmia is related to structural heart disease; or if a target arrhythmia has been treated by an implanted ICD. Successful completion of this clinical trial will result in the US clearance for the Durablate catheter and will offer an underserved patient population a better quality of life and the possibility of a cure.