Correlation between the radiation dose and myocardial remodeling after stereotactic radiation therapy for ventricular tachycardia: First assessment of the dose-effect relationship in humans

Bénali, Karim; Rigal, Louis; Simon, Antoine; Bellec, J.; Jaı̈s, Pierre; Kamakura, Tsukasa; Robinson, C.G.; Cuculich, Phillip S.; Crevoisier, R. de; Martins, Raphaël P.

doi:10.1016/j.hrthm.2022.04.017

Cited by 9 publications

(8 citation statements)

References 4 publications

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“…This procedure confirmed another VT exit localized at the border zone of an SBRT-altered scar. Of note, our electrophysiological findings regarding scar modifications are also in line with a recent work published by Benali et al 37 showing a correlation between radiation dose and myocardial remodeling with significant reduction of bipolar voltage beyond 20 Gy. Such correlation was also previously observed in animal models at 25 Gy.…”

Section: Discussionsupporting

confidence: 92%

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Ninni

Gallot-Lavallée

Klein

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy for treating refractory ventricular tachycardia (VT) despite optimal medical treatment and catheter ablation. However, data on the use of SBRT in patients with electrical storm (ES) is lacking. The aim of this study was to assess the clinical outcomes associated with SBRT in the context of ES. Methods: This retrospective study included patients who underwent SBRT in the context of ES from March 2020 to March 2021 in one tertiary center (CHU Lille). The target volume was delineated according to a predefined workflow. The efficacy was assessed with the following end points: sustained VT recurrence, VT reduced with antitachycardia pacing, and implantable cardioverter defibrillator shock. Results: Seventeen patients underwent SBRT to treat refractory VT in the context of ES (mean 67±12.8 age, 59% presenting ischemic heart disease, mean left ventricular ejection fraction: 33.7± 9.7%). Five patients presented with ES related to incessant VT. Among these 5 patients, the time to effectiveness ranged from 1 to 7 weeks after SBRT. In the 12 remaining patients, VT recurrences occurred in 7 patients during the first 6 weeks following SBRT. After a median 12.5 (10.5–17.8) months follow-up, a significant reduction of the VT burden was observed beyond 6 weeks (−91% [95% CI, 78–103]), P <0.0001). The incidence of implantable cardioverter defibrillator shock and antitachycardia pacing was 36% at 1 year. Conclusions: SBRT is associated with a significant reduction of the VT burden in the event of an ES; however, prospective randomized control trials are needed. In patients without incessant VT, recurrences are observed in half of patients during the first 6 weeks. VT tolerance and implantable cardioverter defibrillator programming adjustments should be integrated as part of an action plan defined before SBRT for each patient.

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Section: Discussionsupporting

confidence: 92%

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Ninni

Gallot-Lavallée

Klein

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…These ndings suggest that radioablation's acute anti-arrhythmic impact may involve increased conduction due to upregulation of gap junctions in the target area (3). However, in the recent case report of Benali K. et al, they observed the reduction in bipolar voltages for the myocardium exposed to radiation doses > 15 Gy and suggested that two antiarrhythmic effects of SBRT may coexist: an early impact described by electrical cell reprogramming and a later ablative effect explained by enhanced scar formation (27). Consistent with these ndings, we observed the acute suppression of VT episodes beginning with the immediate after the procedure.…”

Section: Discussionsupporting

confidence: 90%

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

Aras

Çetin²,

Ozturk

et al. 2022

Preprint

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Background: Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients' procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT's efficacy as well as the value of using a blanking period following a SBRT session.Methods: Eight patients (mean age 58 ±14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area.Results: During a median follow-up of 8 months, all patients demonstrated VT recurrences, however, implantable cardioverter-defibrillator (ICD) therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p=0.047; 18.50 to 3.29/per month, p=0.036, respectively). While analyzing the temporal SBRT outcomes, the two weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions: Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT doesn’t seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

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“…These findings suggest that radioablation’s acute anti-arrhythmic impact may involve increased conduction due to upregulation of gap junctions in the target area [ 3 ]. However, in the recent case report of Benali K. et al, they observed the reduction in bipolar voltages for the myocardium exposed to radiation doses > 15 Gy and suggested that two antiarrhythmic effects of SBRT may coexist: an early impact described by electrical cell reprogramming and a later ablative effect explained by enhanced scar formation [ 27 ]. Consistent with these findings, we observed the acute suppression of VT episodes beginning with the immediate after the procedure.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

Aras

Çetin

Ozturk

et al. 2022

J Interv Card Electrophysiol

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Background Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients’ procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT’s efficacy as well as the value of using a blanking period following a SBRT session. Methods Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area. Results During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

show abstract

Correlation between the radiation dose and myocardial remodeling after stereotactic radiation therapy for ventricular tachycardia: First assessment of the dose-effect relationship in humans

Cited by 9 publications

References 4 publications

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

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