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. 2024 May 2;26(5):euae110.
doi: 10.1093/europace/euae110.

Stereotactic arrhythmia radioablation and its implications for modern cardiac electrophysiology: results of an EHRA survey

Boldizsar Kovacs  1   2 , Helge Immo Lehmann  1   3 , Martin Manninger  4 , Ardan Muammer Saguner  2 , Piotr Futyma  5 , David Duncker  6 , Julian Chun  7
Affiliations

Stereotactic arrhythmia radioablation and its implications for modern cardiac electrophysiology: results of an EHRA survey

Boldizsar Kovacs et al. Europace. .

Abstract

Stereotactic arrhythmia radioablation (STAR) is a treatment option for recurrent ventricular tachycardia/fibrillation (VT/VF) in patients with structural heart disease (SHD). The current and future role of STAR as viewed by cardiologists is unknown. The study aimed to assess the current role, barriers to application, and expected future role of STAR. An online survey consisting of 20 questions on baseline demographics, awareness/access, current use, and the future role of STAR was conducted. A total of 129 international participants completed the survey [mean age 43 ± 11 years, 25 (16.4%) female]. Ninety-one (59.9%) participants were electrophysiologists. Nine participants (7%) were unaware of STAR as a therapeutic option. Sixty-four (49.6%) had access to STAR, while 62 (48.1%) had treated/referred a patient for treatment. Common primary indications for STAR were recurrent VT/VF in SHD (45%), recurrent VT/VF without SHD (7.8%), or premature ventricular contraction (3.9%). Reported main advantages of STAR were efficacy in the treatment of arrhythmias not amenable to conventional treatment (49%) and non-invasive treatment approach with overall low expected acute and short-term procedural risk (23%). Most respondents have foreseen a future clinical role of STAR in the treatment of VT/VF with or without underlying SHD (72% and 75%, respectively), although only a minority expected a first-line indication for it (7% and 5%, respectively). Stereotactic arrhythmia radioablation as a novel treatment option of recurrent VT appears to gain acceptance within the cardiology community. Further trials are critical to further define efficacy, patient populations, as well as the appropriate clinical use for the treatment of VT.

Keywords: European Heart Rhythm Association; Stereotactic arrhythmia radioablation; Survey.

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Conflict of interest statement

Conflict of interest: B.K., H.I.L., and J.C. have nothing to declare. D.D. received modest lecture honorary, travel grants, and/or a fellowship grant from Abbott, AstraZeneca, Biotronik, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, CVRx, Medtronic, MicroPort, Pfizer, Sanofi, and Zoll. M.M. reports receiving speaker fees from Abbott, Bayer, Biosense Webster, Biotronik, Amomed, AOP Orphan, Boston Scientific, Daiichi Sankyo, and BMS/Pfizer and research grants from Biosense Webster and Abbott. A.M.S. received educational grants through his institution from Abbott, Bayer Healthcare, Biosense Webster, Biotronik, Boston Scientific, BMS/Pfizer, and Medtronic and speaker/advisory board/consulting fees from Bayer Healthcare, Biotronik, Daiichi Sankyo, Medtronic, Novartis, BMS/Pfizer, StrideBio Inc., and Zoll. P.F. reports patent applications related to bipolar and high-voltage ablation and has equity in CorSystem.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
The perceived current role of STAR in the management of ventricular arrhythmias. STAR, stereotactic arrhythmia radioablation; CA, catheter ablation; AAD, antiarrhythmic drug; VT/VF, ventricular tachycardia/fibrillation; PVC, premature ventricular contraction.
Figure 2
Figure 2
Consideration of patients for STAR. Survey participants indicated willingness to perform STAR or refer patients for STAR either in a clinical or research setting. STAR, stereotactic arrhythmia radioablation.
Figure 3
Figure 3
Reasons indicated why STAR may not be adopted as a treatment by surveyed physicians.
Figure 4
Figure 4
Expected most likely clinical role of STAR in 5–10 years. STAR, stereotactic arrhythmia radioablation; VT/VF, ventricular tachycardia/fibrillation; PVC, premature ventricular contraction; SHD, structural heart disease.
See this image and copyright information in PMC

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