Key result
Cardiorespiratory motion in patients with ventricular tachycardia was primarily driven by respiratory excursion (12.12 ± 4.10 mm) compared to cardiac excursion (1.62 ± 1.21 mm).
Why the study?
Cardiac radioablation targets are subject to cardiorespiratory motion, but data regarding the magnitude of this motion are limited despite its importance for treatment planning.
Observational (n=44)
Yes
Cardiorespiratory motion during cardiac radioablation is primarily driven by respiratory displacement, and patient-specific quantification using electroanatomic mapping may help optimize treatment volumes and reduce radiation exposure.
Background: Cardiac radioablation is a new treatment for patients with refractory ventricular tachycardia (VT). The target for cardiac radioablation is subject to cardiorespiratory motion (CRM), the heart's movement with breathing and cardiac contraction. Data regarding the magnitude of target CRM are limited but are highly important for treatment planning. Objectives: The study sought to assess CRM amplitude by using ablation catheter geometrical data. Methods: Electroanatomic mapping data of patients undergoing catheter ablation for VT at 3 academic centers were exported. The spatial position of the ablation catheter as a function of time while in contact with endocardium was analyzed and used to quantify CRM. Results: Forty-four patients with ischemic and nonischemic cardiomyopathy and VT contributed 1364 ablation lesions to the analysis. Average cardiac and respiratory excursion were 1.62 ± 1.21 mm and 12.12 ± 4.10 mm, respectively. The average ratio of respiratory to cardiac motion was approximately 11:1. CRM was greatest along the craniocaudal axis (9.66 ± 4.00 mm). Regional variations with respect to respiratory and cardiac motion were observed: basal segments had smaller displacements vs midventricular and apical segments. Patient characteristics (previous cardiac surgery, height, weight, body mass index, and left ventricular ejection fraction) had a statistically significant, albeit clinically moderate, impact on CRM. Conclusion: CRM is primarily determined by respiratory displacement and is modulated by the location of the target and the patient's biometric characteristics. The patient-specific quantification of CRM may allow to decrease treatment volume and reduce radiation exposure of surrounding organs at risk while delivering the therapeutic dose to the target.
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Petzl et al. (2024) conducted an observational in Ventricular tachycardia with ischemic and nonischemic cardiomyopathy (n=44). Cardiorespiratory motion was evaluated on Cardiac and respiratory excursion. Cardiorespiratory motion in patients with ventricular tachycardia was primarily driven by respiratory excursion (12.12 ± 4.10 mm) compared to cardiac excursion (1.62 ± 1.21 mm).
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