Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia
Why the study?
Does noninvasive cardiac radioablation reduce episodes of ventricular tachycardia in patients with high-risk, refractory ventricular tachycardia?
Population
5 patients with high-risk, refractory ventricular tachycardia
Design
Case_series
Follow-up
46 patient-months (after a 6-week blanking period)
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
TTCTMD
“They did have recurrences, but what is important to note and emphasize is that the burden of VT and the phenotype of VT improved significantly where, in most of the patients, VT became occasionally asymptomatic and ATP-terminated as opposed to having shocks and having a significant impact on thei...”
Implication
Supports evaluation of radioablation for refractory VT; leaves open confirmation of safety and efficacy in prospective trials.
Key Points
- To evaluate the feasibility, safety, and efficacy of combining noninvasive electrocardiographic imaging with stereotactic body radiation therapy (SBRT) for catheter-free cardiac radioablation in patients with refractory ventricular tachycardia.
- Intervention conducted in 5 awake patients with high-risk, refractory ventricular tachycardia treated with a single 25-Gy fraction of stereotactic body radiation therapy.
- Arrhythmogenic scar areas were targeted by combining anatomical imaging with electrocardiographic imaging during ICD-induced ventricular tachycardia.
- Arrhythmia frequency was tracked via implantable cardioverter-defibrillators, and safety was evaluated with serial cardiac and thoracic imaging.
- Ablation took a mean of 14 minutes (range, 11 to 18 min) and reduced ventricular tachycardia episodes from 6,577 in the 3 months pre-treatment to 4 episodes across 46 post-blanking patient-months, representing a 99.9% reduction.
- Ventricular tachycardia burden decreased in all 5 patients, and mean left ventricular ejection fraction did not decline.
- Mild adjacent lung inflammatory opacities observed at 3 months post-treatment completely resolved by 1 year.
Structured PICO
Does noninvasive cardiac radioablation reduce episodes of ventricular tachycardia in patients with high-risk, refractory ventricular tachycardia?
P
Population
5 patients with high-risk, refractory ventricular tachycardia
I
Intervention
Noninvasive cardiac radioablation using stereotactic body radiation therapy (SBRT) guided by anatomical and noninvasive electrocardiographic imaging, delivered as a single fraction of 25 Gy while awake
O
Outcome
Episodes of ventricular tachycardia, as recorded by implantable cardioverter-defibrillators (ICDs)
Noninvasive electrophysiology-guided cardiac radioablation markedly reduced the burden of ventricular tachycardia in patients with refractory disease.
Cite This Study
Cuculich et al. (2017) studied this question.