Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients

Lloyd, Michael S.; Wight, John; Schneider, Frank; Hoskins, Michael; Attia, Tamer; Escott, C.; Lerakis, Stamatios; Higgins, Kristin

doi:10.1016/j.hrthm.2019.09.028

Cited by 104 publications

(166 citation statements)

References 11 publications

Supporting

Mentioning

147

Contrasting

Unclassified

Order By: Relevance

“… 5 6 7 8 The efficacy and safety of radioablation for ventricular tachyarrhythmia has been recently evaluated in human studies. 1 2 3 9 10 Compared with conventional RFCA, radioablation is more likely to produce homogenous transmural lesions which can provide greater benefit in electrical and pathologic modulation of the arrhythmogenic substrates.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

Park

Choi

2020

J Korean Med Sci

View full text Add to dashboard Cite

Stereotactic cardiac radiation for ablation (radioablation) of life-threatening ventricular arrhythmia was recently introduced into clinical practice. A 76-year-old male patient with apical hypertrophic cardiomyopathy at burnout stage, who received defibrillator implantation for the secondary prevention of sudden arrhythmic death, was admitted for repeated defibrillator therapy. Radiofrequency catheter ablation was unsuccessful due to the induction of ventricular fibrillation (VF) and hemodynamically unstable sustained monomorphic ventricular tachycardia (VT). However, intracardiac activation mapping for the induced VT revealed the earliest ventricular activation at the apical aneurysm. Radioablation was performed to control VT and VF storm refractory to antiarrhythmic drug therapy. A total of 24 Gray was radiated, divided into three fractions around the apical aneurysm. The onset of electrical modulation was instantaneous and the antiarrhythmic effect was maintained for at least 6 months without significant radiation toxicities. This case suggests that radioablation may be considered as a rescue therapy for VT and VF storm refractory to other treatment modalities.

show abstract

Section: Discussionmentioning

confidence: 99%

Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

Park

Choi

2020

J Korean Med Sci

View full text Add to dashboard Cite

show abstract

“…Second, clinical CRs on SBRT to manage peculiar oncological cardiac localization (mostly sarcomas) ( 15 ). Finally, some CRs ( 8 , 9 , 16 ), two case series (CS) ( 2 , 7 ) and the result of a Phase I/II trial ( 6 ) investigated the application of SBRT in the cardiological frame (STAR). In particular, both the first report of Cuculich et al ( 2 ) and the recent Phase I/II trial (Encore VT) from the same Group ( 6 ) suggested the efficacy and safety of such procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Catheter ablation is the current gold standard treatment for VT in several cardiomyopathies ( 3 ), nevertheless its efficacy is limited by anatomical findings of reentry and not rarely associated with high risks of procedural complication and death ( 4 , 5 ). Recent case series (CS) report about the efficacy and safety of stereotactic arrhythmia radioablation (STAR) ( 6 , 7 ), but these reports collect together <30 patients. To this regard, some case reports (CR) also provided insights in this regard addressing different perspectives of this new approach (i.e., STAR) for a well-established procedure (i.e., SBRT) ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Narducci

Cellini

Placidi

et al. 2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Introduction: Although catheter ablation is the current gold standard treatment for refractory ventricular arrhythmias, sometimes its efficacy is not optimal and it's associated with high risks of procedural complication and death. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted for such clinical presentation, considering its efficacy and safety.Case Presentation: We do report our experience managing a case of high volume of left ventricle for refractory ventricular tachycardia in advanced heart failure patient, by delivering a single fraction of STAR through an highly personalization of dose delivery applying repeated inter- and continuous intra-fraction image guidance.Conclusion: According to the literature reports, we recommend considering increasing as much as possible the personalization features and safety technical procedure as long as that is not significantly affecting the STAR duration. Moreover, the duration in itself shouldn't be the main parameter, but balanced into the frame of possibly obtainable outcome improvement. At best of our knowledge, this is the first report applying such specific technology onto this clinical setting. Future studies will clarify these issues.

show abstract

“…A peculiarity of this study is availability of cardiac histology on three patients that received heart transplant after the treatment. Based on a preliminary microscopic analysis, treated regions indicated edema, and vacuolization of endothelial cells with mild fibrosis, in one case disruption of intercalated disc/gap junction areas, which may explain the relatively acute treatment responses (35).…”

Section: Stereotactic Radioablationmentioning

confidence: 97%

Future Perspectives and New “Frontiers” in Cardiac Rhythmology

Anselmino

Ferrari

2020

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients

Cited by 104 publications

References 11 publications

Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Future Perspectives and New “Frontiers” in Cardiac Rhythmology

Contact Info

Product

Resources

About