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. 2025 Nov 14:S0360-3016(25)06473-9.
doi: 10.1016/j.ijrobp.2025.11.001. Online ahead of print.

LONGITUDINAL TRENDS IN MYOCARDIAL METABOLIC UPTAKE FOLLOWING STEREOTACTIC ARRHYTHMIA RADIOABLATION USING 18FDG-PET/CT

Gerard M Walls  1 , Geoffrey D Hugo  2 , Rugheed Ghadban  3 , Ali Javaheri  3 , Kaitlin Ms Moore  2 , Pamela K Woodard  4 , Richard LaForest  4 , Scott M Bugenhagen  4 , Nels C Knutson  2 , Daniel H Cooper  5 , Stacey L Rentschler  3 , Pamela P Samson  2 , Clifford G Robinson  2 , Phillip S Cuculich  3 , Carmen Bergom  2
Affiliations

LONGITUDINAL TRENDS IN MYOCARDIAL METABOLIC UPTAKE FOLLOWING STEREOTACTIC ARRHYTHMIA RADIOABLATION USING 18FDG-PET/CT

Gerard M Walls et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose/objectives: Ventricular tachycardia (VT) is a life-threatening rhythm disturbance of the heart that has been shown to be amenable to treatment with stereotactic body radiation therapy, known as stereotactic arrhythmia radioablation (STAR). The metabolic impact of directly targeting arrhythmogenic regions of scarred left ventricle (LV) is unknown. In this study, the relationship between radiation dose and 18[F]-FDG-PET uptake in LV segments following STAR was interrogated.

Materials/methods: Patients with VT in the XXXXXXXX trial received a 25 Gy single-fraction of STAR to an electrophysiology-guided target volume planned on 4D-CT. Patients underwent 18[F]-FDG-PET/CT ± MRI at baseline, day 3 and day 90. Auto-segmentation of the LV into the AHA 17-segment model was performed on planning CTs & PET/CTs, allowing median radiation dose and standardized uptake value (SUV) to be extracted. Change in segment median SUV was correlated with dose and clinical outcomes (implanted cardiac defibrillator (ICD) shock, death).

Results: Nineteen patients received STAR. Median VT episodes were reduced from 119 in the 6 months before versus 3 in the six months after STAR (p<0.001). Targeted LV segments had lower baseline 18[F]-FDG SUV than non-targeted segments (p<0.001). Median SUV of targeted segments at baseline, day 3 & day 90 were 1.43, 1.67 & 2.52 (p=0.012). At day 3, a ≥20% SUV increase in targeted segments (n=7/19) was associated with improved survival (HR 0.10, p=0.005). At day 90, there was a trend toward weak association between increased median whole LV myocardium SUV and improved LV ejection fraction (R2=0.355, p=0.158). In logistic regression models, SUV values, together with cardiomyopathy type, VT storm occurrence, and amiodarone use, predicted ICD shocks (p=0.027) and death (p=0.016).

Conclusions: In this small hypothesis-generating study, late SUV increases (day 90) were observed in targeted segments, consistent with VT burden reduction. Further longitudinal studies with 18[F]-FDG-PET/CT after STAR will define how SUV dynamics can be optimally incorporated as a biomarker in practice.

Keywords: Stereotactic arrhythmia radioablation; Ventricular Tachycardia; myocardial metabolism; positron emission tomography-computed tomography; standardized uptake value.

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Conflict of interest statement

Declaration of competing interest GW participated in educational events, conference analysis and an advisory board for AstraZeneca, unrelated to this topic. GH has advisory or consulting roles for Varian Medical Systems, research funding for his institution from Varian Medical Systems, ViewRay, Mevion Medical Systems, Siemens Healthineers, and a pending patent (licensed to Varian Medical Systems). RGH has no relevant conflicts. AJ has received research grants for his institution from AstraZeneca, Reprieve, and Bitterroot Bio, has ownership interest of Mobius scientific and has licensed intellectual property for treatment of eye diseases. KM has no relevant conflicts. PW has received unrelated NIH and DOD funding and has unrelated research relationships with Siemens. RL has no relevant conflicts. SB has no relevant conflicts. NK has received research funding for his institution from Radformation. DC has had consulting/advisory roles for Medtronic, Boston Scientific and Volta Medical, and conference travel support from Abbott. SR has received unrelated research funding for her institution from Varian Medical Systems. PS has received speaking honoraria from Varian Medical Systems and AstraZeneca. CR has a leadership role in Radialogica and EmpNia, stock or other ownership interests in Radialogica, EmpNia and Quantaras, advisory or consulting roles for Varian Medical Systems, AstraZeneca, EMD Serorno and Quantaras, has received research funding for his institution from Varian Medical Systems and Merck, and has relevant patents (WO 2017078757 A1, Provisional App. No. 62/598,162). PC has no relevant conflicts. CB has no relevant conflicts.

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