Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

Abstract

BackgroundOptions for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option.MethodsSeven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used.ResultsAcute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure.ConclusionsCardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.

Safety and Efficacy of Stereotactic Arrhythmia Radioablation for the Treatment of Ventricular Tachycardia: A Systematic Review

“…Three retrospective case series (7)(8)(9), two retrospective (10,11), and five prospective studies (12)(13)(14)(15)(16) were included in our systematic review. The baseline characteristics of the patients included in the analysis are reported in Table 1.…”

Non-Oncological Radiotherapy: A Review of Modern Approaches

“…After 6 months, for the five patients analysed VT burden was reduced by 85%, with no high-grade acute toxicity and three deaths due to heart failure. [ 15 ].…”

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

“…Advanced arrhythmia source mapping for STAR has been performed based upon the results of invasive EAM mapping, electrocardiographic imaging (ECGi) with different systems ( 9 , 26 , 29 – 31 ), or even computational ECG mapping algorithms based on vectorcardiographic data analysis ( 32 ); to identify the GTV, electroanatomical data were then combined with anatomical and/or viability data obtained using different imaging techniques such as cardiac magnetic resonance imaging ( 9 , 10 , 33 , 34 ), cardiac single-photon emission CT ( 9 , 10 ), or CE cardiac CT ( 27 , 30 , 31 , 33 – 35 ). Recent data suggest that enlarging the GTV to the entire potential arrhythmogenic substrates as identified by EAM substrate mapping may not provide further benefits compared to only targeting the critical isthmus of the clinical VT, while increasing side effects ( 36 ).…”