Stereotactic Non-invasive Ablation of Ventricular Tachycardia
Stereotactic Non-invasive Ablation of Ventricular Tachycardia
STereotactic Ablative Radiosurgery of recurrent Ventricular Tachycardia in structural heart
 disease (STAR-VT).
The goal of this project is to evaluate feasibility and safety/toxicity of elimination of
 ventricular tachycardia (VT) associated with structural heart disease by noninvasive
 strategy, stereotactic radiosurgical ablation in an indication of bail-out procedure after
 failed catheter ablation. The arrhythmogenic substrate will be identified by imaging
 techniques and functionally by electroanatomic mapping and pacing. The recipients of
 stereotactic surgery will be patients after 2 unsuccessful catheter ablations for monomorphic
 VTs (one of the procedures will be performed in an expert center). The target volume for
 stereotactic radiosurgical ablation (single dose of 25 Gy) will be a critical region of the
 substrate defined by a combination of imaging and functional methods with an export of the
 merged image-electroanatomical map into the radiosurgery planning console. Primary endpoints
 will be a reduction of the burden of sustained VT, time to death or arrhythmic storm or
 appropriate therapy with implantable cardioverter-defibrillator (ICD) for isolated VT and/or
 time do development of radiation toxicity (both acute and late).
Inclusion Criteria:

 -  Patients with structural heart disease (ischemic and non-ischemic cardiomyopathy,
 previous surgery for congenital heart disease)

 -  Implanted ICD or CRT-D (cardiac resynchronization therapy defibrillator)

 -  Prior ≥1 catheter ablation procedure for monomorphic VT

 -  VT recurrence early (<12 months) after the last ablation with at least 2 episodes of
 recurrent VT, including 1 episode while on amiodarone (if not contraindicated)

 -  Age ≥30 years

 -  Signed an IRB-approved (Institutional Review Board) written informed consent

 Exclusion Criteria:

 -  Acute myocardial infarction or recent percutaneous coronary intervention (PCI) or
 cardiac surgery (<3 months)

 -  Primary electrical disease (channelopathy)

 -  Reversible cause of VT (e.g. drug-induced, intoxications, etc)

 -  Pregnancy or breastfeeding

 -  Chronic heart failure New York Heart Association (NYHA) Class IV

 -  Serious comorbidities with presumed life expectancy less than one year

 -  Significant peripheral artery disease precluding retrograde aortic mapping

 -  History of chest radiotherapy