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. 2021 Sep;61(3):583-593.
doi: 10.1007/s10840-020-00855-2. Epub 2020 Aug 27.

STRA-MI-VT (STereotactic RadioAblation by Multimodal Imaging for Ventricular Tachycardia): rationale and design of an Italian experimental prospective study

C Carbucicchio #  1 , B A Jereczek-Fossa #  2   3 , D Andreini  4   5 , V Catto  6 , G Piperno  3 , E Conte  4 , F Cattani  7 , E Rondi  7 , S Vigorito  7 , C Piccolo  7   8 , A Bonomi  9 , A Gorini  2   10 , M Pepa  3 , S Mushtaq  4 , G Fassini  6 , M Moltrasio  6 , F Tundo  6 , G Marvaso  2   3 , F Veglia  9 , R Orecchia  11 , E Tremoli  12 , C Tondo  6   5
Affiliations

STRA-MI-VT (STereotactic RadioAblation by Multimodal Imaging for Ventricular Tachycardia): rationale and design of an Italian experimental prospective study

C Carbucicchio et al. J Interv Card Electrophysiol. 2021 Sep.

Abstract

Background: Ventricular tachycardia (VT) is a life-threatening condition, which usually implies the need of an implantable cardioverter defibrillator in combination with antiarrhythmic drugs and catheter ablation. Stereotactic body radiotherapy (SBRT) represents a common form of therapy in oncology, which has emerged as a well-tolerated and promising alternative option for the treatment of refractory VT in patients with structural heart disease.

Objective: In the STRA-MI-VT trial, we will investigate as primary endpoints safety and efficacy of SBRT for the treatment of recurrent VT in patients not eligible for catheter ablation. Secondary aim will be to evaluate SBRT effects on global mortality, changes in heart function, and in the quality of life during follow-up.

Methods: This is a spontaneous, prospective, experimental (phase Ib/II), open-label study (NCT04066517); 15 patients with structural heart disease and intractable VT will be enrolled within a 2-year period. Advanced multimodal cardiac imaging preceding chest CT-simulation will serve to elaborate the treatment plan on different linear accelerators with target and organs-at-risk definition. SBRT will consist in a single radioablation session of 25 Gy. Follow-up will last up to 12 months.

Conclusions: We test the hypothesis that SBRT reduces the VT burden in a safe and effective way, leading to an improvement in quality of life and survival. If the results will be favorable, radioablation will turn into a potential alternative option for selected patients with an indication to VT ablation, based on the opportunity to treat ventricular arrhythmogenic substrates in a convenient and less-invasive manner.

Keywords: Cardiac radiosurgery; Catheter ablation; Radioablation; Stereotactic body radiotherapy; Ventricular tachycardia.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of STRA-MI-VT study. Legend: CT, computed tomography; ECG, electrocardiogram; OARs, organs at risk; QoL, quality of life; SBRT stereotactic body radiotherapy; VT ventricular tachycardia
Fig. 2
Fig. 2
Diagnostic imaging obtained by cardiac CT combined with EAM to guide patient’s SBRT treatment. Upper panel: LV short axis view of cardiac CT scan obtained 8 min after iodinated contrast administration. Hyper-density on inferior and postero-lateral LV wall is well evident and represents transmural myocardial fibrosis with ischemic pattern extending from the base to the apex of LV. Central panel: High-density epicardial EAM combined with CT imaging. A large portion of the inferior wall is covered by diseased electrograms, with decreased amplitude (<< 1.0 mV, red-to-yellow in the “color-coded” map), as expression of an underlying electrical “dense scar.” In the same location, CT shows a pattern of discrete transmural fibrosis, thus perfectly matching the lesion revealed by EAM. Lower panel: The inferior panel shows the coverage (95% isodose) of the target volume obtained after optimization of treatment plan. The target volume is the result of imaging integration between simulation and diagnostic CT, and EAM. Legend: CT, computed tomography; EAM, electroanatomical mapping; LV left ventricle; SBRT stereotactic body radiotherapy
See this image and copyright information in PMC

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