August 2, 2026European Heart Journal5 citations
View Full PaperFirst two MRI guided stereotactic body radiation therapy of recurrent sustained ventricular tachycardia
Key Result
Real-time magnetic resonance image guided stereotactic body radiation therapy (25Gy) was feasible and safe in 2 patients with recurrent ventricular tachycardia, with 1 free from VT at 6 months.
Key Points
- This research aims to explore the use of MRI guided stereotactic body radiation therapy for patients with recurrent ventricular tachycardia and electrical storm.
- Two male patients aged 71 and 74 underwent MR-SBRT for recurrent ventricular tachycardia and electrical storm.
- A single fraction of 25Gy was delivered to specific cardiac regions identified through imaging.
- Interdisciplinary decision-making guided the treatment approach, emphasizing palliative intent.
- Patient A experienced radiation-induced inflammation but showed significant quality of life improvement.
- Patient B remained free from ventricular tachycardia over six months post-treatment.
- Left-ventricular ejection fraction was stable at 25% for both patients.
Study Design
Type
Case Report (n=2)
Structured PICO
Does real-time MR-SBRT improve outcomes in patients with refractory ventricular tachycardia and electrical storm due to dilated cardiomyopathy?
P
Population
2 male patients, aged 71 and 74, with recurrent sustained ventricular tachycardia and electrical storm due to dilated cardiomyopathy, treated with MR-SBRT.
I
Intervention
Real-time magnetic resonance image guided stereotactic body radiation therapy (MR-SBRT) delivered as a single fraction of 25Gy at isodose 80% to a planned target volume.
O
Outcome
Feasibility, safety, and short-term efficacy (reduction in VT/ICD shocks)safety
Real-time MR-SBRT is feasible for refractory ventricular tachycardia, though acute radiation-induced inflammation can occur, highlighting the need for careful post-procedural management.
Abstract
Abstract Background Stereotactic body radiation therapy (SBRT) is emerging as a bail-out treatment in patients suffering from therapy resistant ventricular tachyarrhythmias (VT). Purpose We report the worldwide first cases of real-time magnetic resonance image guided SBRT (MR-SBRT) in recurrent sustained VT and electrical storm (ES) due to dilated cardiomyopathy (DCM). Methods The patients were male, 71- (patient A) and 74-year-old (patients B) suffering from recurrent VT and ES with ICD shocks, despite guideline-directed medical therapy including maximal antiarrhythmic therapy. Patient A had two endocardial radiofrequency catheter ablation (RFA) and one epicardial surgical RFA and patient B had one endocardial RFA prior. An interdisciplinary decision was made to perform MR-SBRT in palliative intent to minimize repetitive ICD shocks. Results Areas of VT-substrate were identified to build a volumetric target using the performed EP studies as well as cardiac MRI and CT. A single fraction of 25Gy at isodose 80% was delivered to a planned target volume of 115.1ml and 73ml in the anterior/anteroseptal basal regions in patients A and B, respectively on a dedicated MR linac using real-time MRI tracking. Patient A developed a prolonged ES interpreted as acute radiation-induced inflammation following the treatment, which ceased two days after administration of high-dose dexamethasone. Patient B had no immediate adverse effects from the treatment. Left-ventricular ejection fraction remained stable in both patients at 25%. Both patients had significant improvement of their quality of life. Patient A died 222 days after MR-SBRT due to recurrent ES at another hospital. Patient B is free from VT over six months after treatment. Conclusion In these first two cases, we demonstrate feasibility, safety and short-term efficacy of MR-SBRT. ICD therapies before and after MR-SBRT Funding Acknowledgement Type of funding source: None