Key result
The survey revealed that while most centers base STAR target definition on mapping during VT (96%) and apply a single 25 Gy fraction (95%), significant variability exists in substrate mapping, motion management, and dosimetry methods across Europe.
Why the study?
A research network was established to evaluate patterns of practice and outcomes of stereotactic arrhythmia radioablation for ventricular tachycardia and harmonize treatment within Europe.
Cross-Sectional (n=31)
Yes
There is substantial heterogeneity in the contemporary European practice of stereotactic arrhythmia radioablation, underscoring an urgent need for standardized target delineation and quality assurance as intended by the STOPSTORM consortium.
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
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Grehn et al. (2023) conducted a cross-sectional in Refractory Ventricular Tachycardia (n=31). Stereotactic Arrhythmia Radioablation (STAR) was evaluated on Current clinical patterns of STAR practice (target definition, dosimetry, quality assurance). The survey revealed that while most centers base STAR target definition on mapping during VT (96%) and apply a single 25 Gy fraction (95%), significant variability exists in substrate mapping, motion management, and dosimetry methods across Europe.
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