Stereotactic Radiotherapy: An Alternative Option for Refractory Ventricular Tachycardia to Drug and Ablation Therapy

Shangguan, Wenfeng; Xu, Gang; Wang, Xin; Zhang, Nan; Liu, Xingpeng; Li, Guangping; Tse, Gary; Liu, Tong

doi:10.3390/jcm11123549

Cited by 6 publications

(6 citation statements)

References 55 publications

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“…However, in most cases, cardiac SBRT did not result in complete resolution of VT in long-term follow-up. Therefore, it is currently recommended to use cardiac SBRT in critically ill patients with treatment-resistant (including CA) ventricular tachycardia and electrical storm [68].…”

Section: Management Of Ventricular Arrhythmias In Lung Cancer Patientsmentioning

confidence: 99%

“…Data on cardiac arrhythmias due to RT are scarce. In a retrospective study, which included 76 LC patients treated from 2010 to 2015 with conventionally fractionated RT, atrial arrhythmias were reported in five patients [68]. The long-term effects of radiotherapy, such as coronary artery disease, cardiomyopathy, valvular heart disease, and heart failure, are much better understood (Supplementary Videos S1 and S2) [4].…”

Section: Radiotherapymentioning

confidence: 99%

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Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

Hawryszko,

Sławiński,

Tomasik

et al. 2023

Cancers

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Cardio-oncology currently faces one of the greatest challenges in the field of health care. The main goal of this discipline is to ensure that patients treated for cancer do not suffer or die from cardiovascular disease. The number of studies on the mechanisms of heart injury during cancer treatment is constantly increasing. However, there is insufficient data on heart rhythm disorders that may result from this treatment. This issue seems to be particularly important in patients with lung cancer, in whom anticancer therapy, especially radiotherapy, may contribute to the onset of cardiac arrhythmias. The observed relationship between cardiac dosimetry and radiotherapy-induced cardiotoxicity in lung cancer treatment may explain the increased mortality from cardiovascular causes in patients after chest irradiation. Further research is essential to elucidate the role of cardiac arrhythmias in this context. Conversely, recent reports have highlighted the application of stereotactic arrhythmia radioablation (STAR) in the treatment of ventricular tachycardia. This review of available studies on the epidemiology, pathogenesis, diagnosis, and treatment of arrhythmias in patients treated for lung cancer aims to draw attention to the need for regular cardiological monitoring in this group of patients. Improving cardiac care for patients with lung cancer has the potential to enhance their overall therapeutic outcomes.

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Section: Management Of Ventricular Arrhythmias In Lung Cancer Patientsmentioning

confidence: 99%

Section: Radiotherapymentioning

confidence: 99%

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

Hawryszko,

Sławiński,

Tomasik

et al. 2023

Cancers

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“…STAR presents as a highly promising procedure with a major decrease in VT episodes and AAD prescriptions. [7][8][9][10][11][12] The treatment target region in the myocardial wall is subject to cardiorespiratory motion that induces position uncertainties, which makes it challenging to achieve a conformal dose delivery. 13 In addition, adjacent organs at risk (OARs) and cardiac substructures are dose sensitive and the cardiorespiratory motioninduced dosimetric uncertainties raise radiation-induced toxicity concerns.…”

Section: Introductionmentioning

confidence: 99%

“…STAR is applied by delivering a single high‐dose fraction (typically 25 Gy) to the VT isthmus. STAR presents as a highly promising procedure with a major decrease in VT episodes and AAD prescriptions 7–12 …”

Section: Introductionmentioning

confidence: 99%

Experimental demonstration of real‐time cardiac physiology‐based radiotherapy gating for improved cardiac radioablation on an MR‐linac

Akdag,

Borman,

Mandija

et al. 2024

Medical Physics

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BackgroundCardiac radioablation is a noninvasive stereotactic body radiation therapy (SBRT) technique to treat patients with refractory ventricular tachycardia (VT) by delivering a single high‐dose fraction to the VT isthmus. Cardiorespiratory motion induces position uncertainties resulting in decreased dose conformality. Electocardiograms (ECG) are typically used during cardiac MRI (CMR) to acquire images in a predefined cardiac phase, thus mitigating cardiac motion during image acquisition.PurposeWe demonstrate real‐time cardiac physiology‐based radiotherapy beam gating within a preset cardiac phase on an MR‐linac.MethodsMR images were acquired in healthy volunteers (n = 5, mean age = 29.6 years, mean heart‐rate (HR) = 56.2 bpm) on the 1.5 T Unity MR‐linac (Elekta AB, Stockholm, Sweden) after obtaining written informed consent. The images were acquired using a single‐slice balance steady‐state free precession (bSSFP) sequence in the coronal or sagittal plane (TR/TE = 3/1.48 ms, flip angle = 48, SENSE = 1.5, , voxel size = , partial Fourier factor = 0.65, frame rate = 13.3 Hz). In parallel, a 4‐lead ECG‐signal was acquired using MR‐compatible equipment. The feasibility of ECG‐based beam gating was demonstrated with a prototype gating workflow using a Quasar MRI4D motion phantom (IBA Quasar, London, ON, Canada), which was deployed in the bore of the MR‐linac. Two volunteer‐derived combined ECG‐motion traces (n = 2, mean age = 26 years, mean HR = 57.4 bpm, peak‐to‐peak amplitude = 14.7 mm) were programmed into the phantom to mimic dose delivery on a cardiac target in breath‐hold. Clinical ECG‐equipment was connected to the phantom for ECG‐voltage‐streaming in real‐time using research software. Treatment beam gating was performed in the quiescent phase (end‐diastole). System latencies were compensated by delay time correction. A previously developed MRI‐based gating workflow was used as a benchmark in this study. A 15‐beam intensity‐modulated radiotherapy (IMRT) plan ( Gy) was delivered for different motion scenarios onto radiochromic films. Next, cardiac motion was then estimated at the basal anterolateral myocardial wall via normalized cross‐correlation‐based template matching. The estimated motion signal was temporally aligned with the ECG‐signal, which were then used for position‐ and ECG‐based gating simulations in the cranial–caudal (CC), anterior–posterior (AP), and right–left (RL) directions. The effect of gating was investigated by analyzing the differences in residual motion at 30, 50, and 70% treatment beam duty cycles.ResultsECG‐based (MRI‐based) beam gating was performed with effective duty cycles of 60.5% (68.8%) and 47.7% (50.4%) with residual motion reductions of 62.5% (44.7%) and 43.9% (59.3%). Local gamma analyses (1%/1 mm) returned pass rates of 97.6% (94.1%) and 90.5% (98.3%) for gated scenarios, which exceed the pass rates of 70.3% and 82.0% for nongated scenarios, respectively. In average, the gating simulations returned maximum residual motion reductions of 88%, 74%, and 81% at 30%, 50%, and 70% duty cycles, respectively, in favor of MRI‐based gating.ConclusionsReal‐time ECG‐based beam gating is a feasible alternative to MRI‐based gating, resulting in improved dose delivery in terms of high rates, decreased dose deposition outside the PTV and residual motion reduction, while by‐passing cardiac MRI challenges.

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“…Stereotactic arrhythmia radioablation (STAR) is a specialized procedure that uses advanced imaging techniques to accurately locate and target the areas of the heart arrhytmic substrate responsible for VT [8][9][10]. This technique involves the use of high-energy radiation beams to induce cellular apoptosis and fibrosis also in viable myocardium providing the electrophysiological substrate for VT occurrence.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

Guarracini

Tritto

Monaco

et al. 2023

JCDD

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Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in some cases. Sustained ventricular tachycardia can be terminated by cardioverter-defibrillator therapies although shocks in particular have been demonstrated to increase mortality and worsen patients’ quality of life. Antiarrhythmic drugs have important side effects and relatively low efficacy, while catheter ablation, even if it is actually an established treatment, is an invasive procedure with intrinsic procedural risks and is frequently affected by patients’ hemodynamic instability. Stereotactic arrhythmia radioablation for ventricular arrhythmias was developed as bail-out therapy in patients unresponsive to traditional treatments. Radiotherapy has been mainly applied in the oncological field, but new current perspectives have developed in the field of ventricular arrhythmias. Stereotactic arrhythmia radioablation provides an alternative non-invasive and painless therapeutic strategy for the treatment of previously detected cardiac arrhythmic substrate by three-dimensional intracardiac mapping or different tools. Since preliminary experiences have been reported, several retrospective studies, registries, and case reports have been published in the literature. Although, for now, stereotactic arrhythmia radioablation is considered an alternative palliative treatment for patients with refractory ventricular tachycardia and no other therapeutic options, this research field is currently extremely promising.

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Stereotactic Radiotherapy: An Alternative Option for Refractory Ventricular Tachycardia to Drug and Ablation Therapy

Cited by 6 publications

References 55 publications

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

Experimental demonstration of real‐time cardiac physiology‐based radiotherapy gating for improved cardiac radioablation on an MR‐linac

Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

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