STAR Power: Noninvasive Radiation Therapy for Ventricular Tachycardia Enters a New Era

The use of cardiac stereotactic body radiation therapy for the treatment of ventricular tachycardia (VT), also termed stereotactic ablative radiation therapy or, increasingly, stereotactic arrhythmia radioablation (STAR), is increasingly used in select patients. STAR has emerged as a promising alternative to invasive catheter ablation (CA) for patients with high-risk refractory VT who have failed prior medical therapy or catheter ablation. Since the publication of the first case series using STAR, our understanding of the mechanisms of STAR, longer-term clinical outcomes, potential side effects, and barriers to widespread adoption of cardiac radioablation has become increasingly clear. In this review, we discuss these topics, the increased adoption of STAR, as well as the challenges that lie ahead for this therapy. In addition, as data strongly suggest that fibrosis alone cannot account for the early decreases in VT events observed post-STAR, we propose adopting the STAR acronym to instead stand for stereotactic arrhythmia radiation therapy.