Key result
cSABR is associated with similar shock-free survival as catheter ablation and ~14% fewer acute complications.
Why the study?
Patients with ischaemic heart disease and drug-refractory ventricular tachycardia who fail catheter ablation have limited long-term options, prompting evaluation of cardiac stereotactic ablative radiotherapy as an emerging alternative.
Does cSABR offer similar shock-free and overall survival compared to catheter ablation in high-risk IHD patients with drug-refractory VT?
Cohort (n=28)
No
Does cSABR offer similar shock-free and overall survival compared to catheter ablation in high-risk IHD patients with drug-refractory VT?
In high-risk IHD patients with drug-refractory VT, cSABR offers similar shock-free and overall survival to catheter ablation, with potentially fewer major acute complications.
Background Catheter ablation (CA) is a common management strategy for drug-refractory ventricular tachycardia (VT) in patients with ischaemic heart disease (IHD). Patients that fail CA, currently have limited long-term management options. Cardiac stereotactic ablative radiotherapy (cSABR) is an emerging alternative treatment which is gaining interest worldwide. Purpose The aim of this study was to provide a real-world comparison of our early experience of cSABR with CA in high-risk patients with IHD at a UK centre. Methods All 6 IHD patients treated with cSABR and 22 consecutive high-risk IHD patients treated with CA at a Teaching Hospital between 2015-2024 were identified. Implantable cardioverter defibrillator and patient electronic record data 1-year pre/post treatment was retrospectively reviewed. Results Both groups were predominantly male (cSABR 100% vs CA 84%) with similar median age at time of treatment (cSABR 74 vs CA 70 years). All patients had PAINESD scores >16. All patients treated with cSABR had previously undergone unsuccessful, or were unsuitable for, CA. Post-treatment shock-free survival was similar between cSABR and CA groups (median 130 vs 118 days). 4/6 cSABR patients observed a reduction in overall VT burden from 1-year pre- to 1-year post-treatment. Overall survival was similar between groups (median 348 vs 365 days). Median admissions days were higher in the CA group (0 vs 10 days). 1 patient treated with cSABR had CA within the follow up window. 5 patients treated with CA had redo CA within the follow up window. Major acute complications were higher in the CA group (0% vs 13.6%), including cardiogenic shock requiring intra-aortic balloon pump insertion (n=2) and death (n=1). Conclusion(s) Our early experience suggests that cSABR offers similar shock-free survival and overall survival to CA with a lower major complication rate. Large, randomised control trials are needed to confirm this finding and inform drug refectory VT management guidelines.Shock-free survival KM curveVT burden 1-yr pre vs 1-yr post cSABR
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Hunnybun et al. (2026) conducted a cohort in Drug-refractory ventricular tachycardia in ischaemic heart disease (n=28). Cardiac stereotactic ablative radiotherapy (cSABR) vs. Catheter ablation (CA) was evaluated on Post-treatment shock-free survival. Cardiac stereotactic ablative radiotherapy (cSABR) yielded similar median shock-free survival (130 vs 118 days) and lower major acute complications (0% vs 13.6%) compared to catheter ablation.
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