Stereotactic arrhythmia radiotherapy: a case study of real-time image-guided noninvasive treatment for ventricular tachycardia

In clinical practice, ventricular tachycardia (VT) is usually treated with antiarrhythmic drugs and catheter ablation. However, drug therapy has a relatively low rate of overall effectiveness and may cause new arrhythmia. Catheter ablation has an approximately 50% recurrence rate for VT patients with non-ischemic cardiomyopathy 1 year postoperatively (1). In the recent years, non-invasive stereotactic body radiotherapy (SBRT) has been used to treat arrhythmia, and several studies have shown significant reductions in VT episodes with few serious toxicities after a 6-week blanking period (2). However, the persistence of the treatment effect has varied across studies; thus, a scalable workflow of image-guided radiotherapy techniques must be created to improve the accuracy of the approach (3). This case report describes the SBRT treatment of a patient with VT who had undergone ineffective radiofrequency ablations. The primary purpose of this case report is to propose a method for accurate movement evaluation and tracking of the arrhythmia target through the registration and fusion of multimodal images. Case presentation