Stereotactic arrhythmia radioablation reduced VT burden by 92% at 6 months, but 60% (12/20) of patients developed recurrences over a median 25 months, all occurring outside the treated volume.
Cohort (n=20)
Does stereotactic arrhythmia radioablation (STAR) provide local efficacy and where do recurrences arise in patients with refractory ventricular tachycardia?
Stereotactic arrhythmia radioablation (STAR) provides effective local ablation for refractory VT, with recurrences commonly occurring outside the treated volume rather than within it.
AIMS: Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. METHODS AND RESULTS: From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14-115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. CONCLUSION: STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
Herrera‐Siklody et al. (Mon,) conducted a cohort in Therapy-refractory ventricular tachycardia (VT) (n=20). Stereotactic arrhythmia radioablation (STAR) was evaluated on Ventricular tachycardia (VT) recurrence. Stereotactic arrhythmia radioablation reduced VT burden by 92% at 6 months, but 60% (12/20) of patients developed recurrences over a median 25 months, all occurring outside the treated volume.