This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Tweet: First-in-man treatment of atrial fibrillation using noninvasive stereotactic radioablation demonstrates feasibility. Abbreviations: AF, atrial fibrillation; AV, atrioventricular; CT, computed tomography; DOAC, direct oral anticoagulant; ECG, electrocardiogram; Gy, Gray; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; LV, left ventricle; MRI, magnetic resonance imaging; PA, posterior-anterior; pAF, paroxysmal atrial fibrillation; PTV, planned treatment volume; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SBRT, stereotactic body radiation therapy; VT, ventricular tachycardia; WACA, wide-area circumferential ablation. AbstractPurpose: Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision. We evaluated the feasibility of stereotactic radioablation for treating paroxysmal AF. Methods:Two patients with drug-refractory paroxysmal AF underwent pulmonary vein isolation with SBRT. After placement of a percutaneous active fixation temporary pacing lead tracking fiducial, computed tomography (CT) angiography was performed to define left atrial anatomy. A tailored planning treatment volume was created to deliver contiguous linear ablations to isolate the pulmonary veins and posterior wall. Patients were treated on an outpatient basis in the radioablation suite.Clinical follow-up was performed through at least 24 months after therapy.Results: Both patients successfully underwent SBRT planning and treatment without significant early or long-term side effects up to 48 months of follow-up. One patient had AF recurrence after 6 months free of arrhythmia, while the second patient remains free of AF after 24 months with fibrosis detected on MRI scan consistent with the ablation lesion set. An incidentally noted small pericardial effusion occurred in one patient.Conclusion: Stereotactic radioablation may be feasible for the treatment of drugrefractory AF. Further evaluation is warranted. K E Y W O R D Sablation, atrial fibrillation, new technology, noninvasive ablation, radioablation, stereotactic

Pulmonary vein isolation using robotic radiosurgery system CyberKnife is a new non-invasive treatment of atrial fibrillation, currently in clinical phase. Robotic radiosurgical pulmonary vein isolation (RRPVI) uses stereotactic, non-invasive (painless) pinpoint radiation energy delivery to a small, precise area to accomplish ablation. The purpose of this report is to describe the finding of an increase in the enhancement of the left atrium demonstrated with the use of cardiac magnetic resonance imaging using late gadolinium enhancement (LGE-CMR) as a result of RRPVI in the first case in the world in humans using CyberKnife as a treatment for paroxysmal atrial fibrillation (PAF).

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