Key result
STAR reduces VT burden with acceptable short-term safety pending long-term efficacy data.
Why the study?
Stereotactic arrhythmia radioablation has emerged as a novel noninvasive option for drug- and ablation-refractory ventricular tachycardia, but current evidence regarding mechanisms, patient selection, planning, and clinical outcomes needed to be summarized.
Does stereotactic arrhythmia radioablation (STAR) reduce VT burden in patients with drug- and ablation-refractory ventricular tachycardia?
Does stereotactic arrhythmia radioablation (STAR) reduce VT burden in patients with drug- and ablation-refractory ventricular tachycardia?
STAR represents a promising noninvasive paradigm shift for managing refractory VT when conventional therapies are ineffective, though long-term safety and efficacy are still being defined.
May offer noninvasive option for refractory VT; leaves open long-term durability and safety.
Stereotactic arrhythmia radioablation (STAR) has emerged as a novel, noninvasive therapeutic option for patients with drug- and ablation-refractory ventricular tachycardia (VT). Derived from stereotactic body radiotherapy (SBRT), STAR enables the delivery of a single, high-dose fraction of ionizing radiation to arrhythmogenic myocardial tissue with submillimeter precision while minimizing exposure to surrounding cardiac and extracardiac structures. This review summarizes current evidence regarding mechanisms of action, patient selection, treatment planning, and clinical outcomes of STAR. Preclinical and early clinical studies suggest that STAR exerts rapid antiarrhythmic effects through modulation of cardiac conduction proteins and potential structural remodeling, though long-term efficacy remains under investigation. Clinical trials and prospective registries report substantial reductions in VT burden with acceptable short-term safety, yet recurrence rates and late toxicities require further evaluation. The European STOPSTORM consortium has been established to standardize treatment protocols, harmonize target delineation, and coordinate multicenter clinical validation. As STAR continues to evolve, multidisciplinary collaboration between radiation oncologists, cardiologists, and medical physicists will be essential to define optimal practice standards, ensure patient safety, and assess long-term outcomes. STAR represents a promising paradigm shift in the management of refractory VT, offering a noninvasive alternative when conventional therapies are ineffective or infeasible.
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Pietro et al. (2025) studied this question. Stereotactic arrhythmia radioablation (STAR) significantly reduces ventricular tachycardia burden with acceptable short-term safety, though long-term efficacy requires further investigation.
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