Key result
SBRT linked to ~59% lower VT burden versus pre-treatment baseline in advanced heart failure.
Why the study?
The role of stereotactic body radiation therapy for refractory ventricular tachycardia in advanced heart failure patients remains unclear due to mixed follow-up results.
Does stereotactic body radiation therapy reduce ventricular tachycardia burden and ICD therapies in patients with advanced heart failure and refractory VT?
Cohort (n=14)
No
Does stereotactic body radiation therapy reduce ventricular tachycardia burden and ICD therapies in patients with advanced heart failure and refractory VT?
Effect estimate: 59% reduction
SBRT provides modest long-term reductions in VT burden and ICD therapies for patients with advanced heart failure and refractory VT, though it is associated with a risk of pneumonitis.
Should not yet change practice for refractory VT; leaves open SBRT efficacy and safety in prospective trials.
Background: Initial studies of stereotactic body radiation therapy (SBRT) for refractory ventricular tachycardia (VT) have demonstrated impressive efficacy. Follow-up analyses have found mixed results and the role of SBRT for refractory VT remains unclear. We performed palliative, cardiac radio ablation in patients with ventricular tachycardia refractory to ablation and medical management. Methods: Arrhythmogenic regions were targeted by combining computed tomography imaging with electrophysiologic mapping with collaboration from a radiation oncologist, electrophysiologist and cardiac imaging specialist. Patients were treated with a single fraction 25 Gy. Total durations of VT, the quantity of antitachycardia pacing (ATP) and shocks before and after treatment as recorded by implantable cardioverter-defibrillators (ICDs) were analyzed. Follow-up extended until most recent device interrogation unless transplant, death or repeat ablation occurred sooner. Results: Fourteen patients (age 50-78, four females) were treated and had an average of two prior ablations. Nine had ACC/AHA Stage D heart failure and three had left ventricular assist devices (LVAD). Two patients died shortly after SBRT, one received a prompt heart transplant and another had significant VT durations in the following months that were inaccurately recorded by their device. Ten of the 14 patients remained with adequate data post SBRT for analysis with an average follow-up duration of 216 days. Seven of those 10 patients had a decrease in VT post SBRT. Comparing the 90 days before treatment to cumulative follow-up, patients had a 59% reduction in VT, 39% reduction in ATP and a 60% reduction in shocks. Four patients received repeat ablation following SBRT. Pneumonitis was the only complication, occurring in four of the fourteen patients. Conclusion: SBRT may have value in advanced heart failure patients with refractory VT acutely but the utility over long-term follow-up appears modest. Prospective randomized data is needed to better clarify the role of SBRT in managing refractory VT.
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Wight et al. (2022) conducted a cohort in Refractory ventricular tachycardia in advanced heart failure (n=14). Stereotactic body radiation therapy (SBRT) vs. Pre-treatment baseline (90 days before treatment) was evaluated on Total ventricular arrhythmia burden (VT/VF/NSVT) (59% reduction). Stereotactic body radiation therapy reduced ventricular tachycardia burden by 59% and ICD shocks by 60% compared to the 90 days prior to treatment in advanced heart failure patients.
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