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. 2021 Sep;61(3):535-543.
doi: 10.1007/s10840-020-00849-0. Epub 2020 Aug 15.

Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience

Robert Chin #  1 , Justin Hayase #  2 , Peng Hu  3 , Minsong Cao  1 , Jie Deng  1 , Olujimi Ajijola  2 , Duc Do  2 , Marmar Vaseghi  2 , Eric Buch  2 , Houman Khakpour  2 , Osamu Fujimura  2 , Yuliya Krokhaleva  2 , Carlos Macias  2 , Julie Sorg  2 , Jean Gima  2 , Geraldine Pavez  2 , Noel G Boyle  2 , Michael Steinberg  1 , Kalyanam Shivkumar  2 , Jason S Bradfield  4
Affiliations

Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience

Robert Chin et al. J Interv Card Electrophysiol. 2021 Sep.

Abstract

Background: Initial studies have reported excellent safety and efficacy for stereotactic body radiation therapy (SBRT) in patients with refractory ventricular tachycardia (VT).

Methods: This is a single-center retrospective analysis of eight consecutive patients who underwent SBRT for refractory, scar-related VT. The anatomic target for radioablation was defined based on surface 12-lead ECG VT morphology, cardiac magnetic resonance imaging, and electroanatomic mapping data when available. The target volume treated and the prescribed radiation dose (15-25 Gy) was based on the combined clinical assessment of the cardiac electrophysiologist and radiation oncologist. Ventricular arrhythmias, radiation-related outcomes, and adverse events were monitored at follow-up.

Results: Eight patients underwent nine SBRT sessions. All patients were male with an average age of 75 ± 7.3 years and mean ejection fraction of 21 ± 7%. SBRT was performed with delivery of an average of 22.2 ± 3.6 Gy in a single session with a procedure time of 18.2 ± 6.0 min. All but one session was performed on an inpatient basis. No acute complications occurred. During a median follow-up of 7.8 months (IQR 4.8, 9.9), ICD therapies decreased from median 69.5 (43.5, 115.8) pre-SBRT to 13.3 (IQR 7.7, 35.8) post-SBRT (p = 0.036). There were three patient deaths in the follow-up period, unrelated to SBRT. Apparent clinical benefit occurred 33% of the time after SBRT.

Conclusions: The patients experienced overall reduction in VT burden following SBRT, though not with the immediate effect seen in other patient series. Further studies (basic, translational, and clinical) are essential to determine the benefit of SBRT and if so, the optimal protocols and patient selection.

Keywords: Ablation; Non-invasive; Stereotactic body radiation therapy; Ventricular tachycardia.

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References

    1. Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2017;72:1677–749. https://doi.org/10.1016/j.jacc.2017.10.053 . - DOI - PubMed
    1. Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, et al. Noninvasive cardiac radiation for ablation of ventricular tachycardia. N Engl J Med. 2017;377(24):2325–36. https://doi.org/10.1056/NEJMoa1613773 . - DOI - PubMed - PMC
    1. Robinson CG, Samson PP, Moore KMS, Hugo GD, Knutson N, Mutic S, et al. Phase I/II trial of electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia. Circulation. 2019;139(3):313–21. https://doi.org/10.1161/CIRCULATIONAHA.118.038261 . - DOI - PubMed - PMC
    1. Scholz EP, Seidensaal K, Naumann P, Andre F, Katus HA, Debus J. Risen from the dead: cardiac stereotactic ablative radiotherapy as last rescue in a patient with refractory ventricular fibrillation storm. HeartRhythm Case Rep. 2019;5(6):329–32. https://doi.org/10.1016/j.hrcr.2019.03.004 . - DOI - PubMed - PMC
    1. Jumeau R, Ozsahin M, Schwitter J, Vallet V, Duclos F, Zeverino M, et al. Rescue procedure for an electrical storm using robotic non-invasive cardiac radio-ablation. Radiother Oncol. 2018;128(2):189–91. https://doi.org/10.1016/j.radonc.2018.04.025 . - DOI - PubMed

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