Radiotherapy vs Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease

Ventricular Tachycardia Clinical Trial

— Radioablate  

Official title:

Radiotherapy vs Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT06360939
• Other study ID #: ETH02659
• Status: Not yet recruiting
• Phase: N/A
• Start date: May 20, 2024
• Est. completion date: May 20, 2027

Study information

• Verified date: April 2024
• Source: Western Sydney Local Health District
• Contact: Saurabh Kumar, MBBS | PhD
• Phone: (02)88908140
• Email: saurabh.kumar[@]health.nsw.gov.au
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The goal of this randomized clinical trial is to test the efficacy of stereotactic body radiation therapy (SBRT) in treating ventricular tachycardia (VT) in patients with advanced structural heart disease. The main questions it aims to answer are:

• What is the efficacy of SBRT compared to catheter ablation (CA) in achieving a ≥ 75% reduction in VT burden at 6 months

• What is the comparable safety profile of SBRT vs CA Researchers will compare SBRT and CA (standard of care).

Description:

Hypothesis

We hypothesise that in an open label randomised controlled trial of patients with advanced structural heart disease and ventricular tachycardia (VT) that stereotactic body radiation therapy (SBRT) will be superior in reducing VT burden compared to standard care comprising of catheter ablation (CA) and routine medical care with acceptable safety and adverse events.

Aims

This is a trial to examine if in an open label randomised trial of 60 patients with structural heart disease and VT followed for 3 years with a minimum follow up of 1 year of SBRT compared CA results in:

1. An improvement in a primary outcome of proportion of patients with a ≥75% reduction in VT burden in the 6 months following intervention compared to the 6 months intervention

2. Comparable safety profile (serious adverse events [SAE] and adverse events of special interest [AESI] at 6 months;

3. reduction in secondary endpoints at 6, 12, 24 and 36 months of: any VT recurrence, absolute % reduction in VT burden compared to 6 months pre-treatment, number of anti-arrhythmic drugs (AADs) compared to pre-treatment, cardiovascular hospitalisation, all-cause mortality, cardiac transplantation, combined endpoint of cardiovascular hospitalisation/transplant/mortality, SAE and AESI from treatment, ventricular function abd change of quality of life (QOL) metrics (at 12 months).

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 60
• Est. completion date: May 20, 2027
• Est. primary completion date: May 20, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. Structural heart disease (including ischaemic cardiomyopathy , non-ischaemic cardiomyopathy or congenital heart disease and defined as any one of

1. segmental or global decreased ventricular wall motion as defined by TTE, CT or cMRI

2. myocardial hypertrophy

3. myocardial scar (evidenced by late gadolinium enhancement on cMRI, wall thinning on cardiac CT, low voltage on electrophysiological study or abnormal intracardiac echocardiography)

2. Recurrent monomorphic VT which can include

1. at least one episode of VT treated by ICD and/or

2. sustained VT (lasting >30s) and/or

3. inducible sustained VT on invasive electrophysiological study (EPS) or non-invasive programmed stimulation (NIPS)

3. PAINESD score of =9 points and/or at least moderate risk of VT recurrence or death as defined by the I-VT score. Both are validated tools used clinically to identify patient at high risk of VT recurrence and/or mortality after CA.

Exclusion Criteria:

1. Age < 18 years

2. Life expectancy < 3 months

3. Catheter ablation deemed futile or with prohibitive risk by cardiac electrophysiologist.

4. Unwilling or unable to provide consent

5. Known cardiac channelopathies (e.g. Catecholaminergic polymorphic ventricular tachycardia (CPVT), long- or short QT syndrome, Brugada syndrome)

6. Contraindications to radiotherapy as deemed by referring physician and/or radiation oncologist

7. Pregnancy or breast feeding

Related Conditions & MeSH terms

• Arrhythmias, Cardiac
• Cardiomyopathies
• Heart Diseases
• Tachycardia
• Tachycardia, Ventricular
• Ventricular Arrythmia
• Ventricular Tachycardia

Intervention

Radiation:
• SBRT
Delivery of 25Gy in a single dose fraction to target area within 6 weeks of randomization

Procedure:
• CA
CA (endocardial and/or epicardial at operator discretion) within 6 weeks of randomization.

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
Western Sydney Local Health District	National Heart Foundation, Australia, University of Sydney

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	VT burden	Change in proportion of patients with a =75% reduction in VT burden at 6 months (number of VT episodes in 6 months post treatment compared to the number of VT episodes in the 6 months prior to randomisation excluding a 6-week blanking period after treatment initiation)	6 months
Secondary	Recurrent sustained VT	Recurrent sustained VT ascertained by implanted cardioverter defibrillator (ICD) (VT identified and treated by the ICD with anti-tachycardia pacing (ATP) and/or internal ICD delivered shock or =30 seconds of VT if untreated by ICD	6, 12, 24 and 36 months
Secondary	VT storm	VT storm (three or more documented episodes of VT within 24 hours or incessant VT)	6, 12, 24 and 36 months
Secondary	Absolute VT burden	Absolute percentage reduction in VT burden compared to pre-ablation	6, 12, 24 and 36 months
Secondary	Serious Adverse Events (SAE) and Adverse Events of Special Interest (AESI)	SAE and AESI related to effects of SBRT; SAE and AESI related to standard care e.g. medical anti-arrhythmic drug therapy or catheter ablation or heart transplantation	At all time points up to 36 months
Secondary	ICD shocks	Implantable Cardioverter Defibrillator shocks	6, 12, 24 and 36 months
Secondary	Hospitalization	Cardiovascular as well as specifically heart failure and arrhythmia	6, 12, 24 and 36 months
Secondary	All cause mortality	All cause mortality	6,12, 24 and 36 months
Secondary	Cardiovascular Mortality	Cardiovascular mortality	6,12, 24 and 36 months
Secondary	Composite outcome of VT recurrence/hospitalisation/death/ cardiac transplantation	Composite outcome as above	6,12, 24 and 36 months
Secondary	Ventricular function	As determined by echocardiography (ejection fraction, speckle tracking echocardiography)	6,12, 24 and 36 months
Secondary	Quality of Life as per Short Form - 36 (SF-36) Score	Change in quality of life at 6 and 12 months (compared to pre-intervention) as measured by Short Form- 36 (SF-36) [0-100 scale, 0 is equivalent to maximum disability and a score of 100 is equivalent to no disability].	6,12, 24 and 36 months
Secondary	Quality of Life as per Implantable Cardioverter Defibrillator Concerns Questionnaire (ICDC) score	Change in quality of life at 6 and 12 months (compared to pre-intervention) as measured by Implantable Cardioverter Defibrillator Concerns Questionnaire (ICDC) score. [0-100 scale, 100 equivalent to maximum concern]	6,12, 24 and 36 months
Secondary	Number of AADs	Number of AADs at time points following randomization	6,12, 24 and 36 months