Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia
Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation for Treatment of Ventricular Tachycardia
Phase I/II Study of EP-guided Noninvasive Cardiac Radioablation (ENCORE) for Treatment of
 Ventricular Tachycardia
Patients with Ventricular Tachycardia (VT) who have failed standard therapy (medicines,
 invasive catheter ablation) have limited options, with one-year survival below 20%.
 Preclinical data demonstrate that single fraction stereotactic body radiotherapy (SBRT) to
 discrete portions of the heart is feasible and may result in a reduction or elimination of
 VT. The efficacy may be further improved when guided by cardiac electrophysiologic (EP)
 testing. In total, the mapping and ablation proposed for this EP-guided Noninvasive Cardiac
 Radioablation (ENCORE) is a rapid and totally non-invasive method. Overall safety and early
 efficacy of ENCORE have not been rigorously studied in a prospective trial to-date. The
 purpose of this phase I/II study is to demonstrate the short-term safety and preliminary
 efficacy of ENCORE for patients with life-threatening, treatment-refractory VT.
Inclusion Criteria:

 1. DOCUMENTED VT:

 1. Patient must have documented sustained monomorphic ventricular tachycardia as
 documented on either a 12-lead ECG or intracardiac ICD interrogation

 - OR-

 2. Monomorphic PVCs documented on a 12-lead ECG.

 2. ANTIARRHYTHMIC MEDICATION: Patient must have failed or become intolerant to at least
 one antiarrhythmic medication (amiodarone, sotalol, or mexiletine).

 -AND-

 3. CATHETER ABLATION: Patient must have failed at least one invasive catheter ablation
 procedure, or have a contraindication to a catheter ablation procedure (e.g., LV
 thrombus, severe pulmonary disease), or have VT thought to arise from a protected
 location (e.g., epicardial VT with history of previous cardiac surgery).

 4. MINIMUM VT BURDEN: Patient must have either:

 1. At least 3 VT episodes (sustained VT, ICD ATP or ICD shock) over previous 6
 months prior to enrollment -OR-

 2. >20% PVC burden with a cardiomyopathy (LVEF<50%)

 5. Patient must be deemed medically fit for stereotactic body radiation therapy by the
 treating physician.

 6. Patient must be > 18 years old.

 7. Patient must be able to understand and be willing to sign an IRB approved written
 informed consent document.

 -

 Exclusion Criteria:

 1. Patient must not have past history of radiotherapy within the projected treatment
 field.

 2. Advanced symptomatic heart failure as defined as NYHA Class IV heart failure (inotrope
 dependent and/or current left-ventricular assist device (LVAD))

 3. Polymorphic VT or ventricular fibrillation (VF) as a clinical heart rhythm (as
 determined by 12-lead ECG and/or ICD interrogation).

 4. More than 3 distinct clinical VT morphologies observed (ECG or ICD interrogation or
 invasive EP study) OR more than 5 distinct induced VT morphologies during ECGI
 testing.

 5. Advanced myocardial scar substrate that would require stereotactic delivery to a
 target volume deemed unsafe by the treating physician.

 6. Unlikely to live 12 months, in the absence of VT, as best based on clinical judgment
 by the treating and enrolling physicians.

 7. Patient must not be pregnant and/or breastfeeding and must have a negative pregnancy
 test within 14 days of study entry.

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