Radiotherapy vs Catheter Ablation for Ventricular Tachycardia in Structural Heart Disease

Who can take part

• Structural heart disease (including ischaemic cardiomyopathy , non-ischaemic cardiomyopathy or congenital heart disease and defined as any one of; segmental or global decreased ventricular wall motion as defined by TTE, CT or cMRI; myocardial hypertrophy; myocardial scar (evidenced by late gadolinium enhancement on cMRI, wall thinning on cardiac CT, low voltage on electrophysiological study or abnormal intracardiac echocardiography)
• Recurrent monomorphic VT which can include; at least one episode of VT treated by ICD and/or; sustained VT (lasting >30s) and/or; inducible sustained VT on invasive electrophysiological study (EPS) or non-invasive programmed stimulation (NIPS)
• 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

Who cannot take part

• Contraindications to radiotherapy as deemed by referring physician and/or radiation oncologist
• Catheter ablation deemed futile or with prohibitive risk by cardiac electrophysiologist
• Known cardiac channelopathies (e.g. Catecholaminergic polymorphic ventricular tachycardia (CPVT), long- or short QT syndrome, Brugada syndrome)
• Age < 18 years
• Life expectancy < 3 months
• Unwilling or unable to provide consent
• Pregnancy or breast feeding