November 1, 2021Open HeartOpen Access

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

View Full Paper

Ask AI

Bookmark

Why the study?

Treatment options remain limited for patients with ventricular tachycardia refractory to antiarrhythmic drugs and/or catheter ablation.

Does non-invasive cardiac stereotactic ablative radiotherapy (SABR) reduce VT burden in patients with recurrent refractory VT?

Structured PICO

Does non-invasive cardiac stereotactic ablative radiotherapy (SABR) reduce VT burden in patients with recurrent refractory VT?

Population

7 patients with recurrent refractory ventricular tachycardia (VT), deemed high risk for either first time or redo invasive catheter ablation

Intervention

Non-invasive cardiac stereotactic ablative radiotherapy (SABR) delivered as a single 25 Gy treatment

Outcome

Acute suppression of VT and reduction in VT burdensurrogate

Cardiac stereotactic ablative radiotherapy (SABR) is a feasible and effective non-invasive option for suppressing refractory ventricular tachycardia in high-risk patients.

Implication

Supports SABR feasibility in refractory VT; hypothesis-generating, needs prospective trials before adoption.

Abstract

BACKGROUND: Options for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option. METHODS: Seven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used. RESULTS: Acute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure. CONCLUSIONS: Cardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.