Stereotactic body radiotherapy reduced the mean number of ventricular tachycardia episodes from 29 at baseline to 11 at 3 months (p=0.05) and 2 at 6 months (p=0.08).
Does a single 25-Gy dose of stereotactic body radiotherapy reduce VT episodes and ICD shocks safely in patients with advanced cardiac disease and intractable ventricular tachycardia?
A single 25-Gy dose of stereotactic body radiotherapy appears safe and may reduce VT episodes and ICD shocks in patients with intractable VT and advanced structural heart disease.
Absolute Event Rate: 11% vs 29%
p-value: p=0.05
PURPOSE: We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT). METHODS: Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks. RESULTS: Seven out of eight patients (men; age, 70 ± 7 years; ejection fraction, 27 ± 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 ± 33 to 11 ± 9 (p = .05) and 2 ± 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients. CONCLUSION: The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy.
Carbucicchio et al. (2021) studied Intractable ventricular tachycardia (n=8). Stereotactic body radiotherapy (SBRT) vs. Baseline (3-month period preceding SBRT) was evaluated on Number of VT episodes at 3 months (p=0.05). Stereotactic body radiotherapy reduced the mean number of ventricular tachycardia episodes from 29 at baseline to 11 at 3 months (p=0.05) and 2 at 6 months (p=0.08).