Advantages and challenges for noninvasive atrial fibrillation ablation

Shoji, Masaaki; Inaba, Koji; Itami, Jun; Hamada, Minoru; Okamoto, Hiroyuki; Iwasa, Takeshi; Ushigusa, Takeshi; Yoshida, Masayuki; Matsuyama, Taka‐aki; Otsuka, Takayuki; Kumagai, Koji; Hirao, Kazuyuki; Maguire, Patrick; Qian, Pierre; Gardner, Edward A.; Zei, Paul C.

doi:10.1007/s10840-020-00904-w

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…The most recent article in the clinical area has been published by Shoji et al ( 64 ): 3 oncologic patients with refractory AF were treated with a target dose of 25–30 Gy in a single fraction delivered by CK. The TV was represented by a “box” lesion set including a circumferential wide-area ablation (WACA) set around pulmonary veins and the maximum follow-up was 24 months.…”

Section: Resultsmentioning

confidence: 99%

“…It is worth saying that, despite the interest in the topic, a limited number of humans has currently undergone STAR for AF and only 2 articles including more than one patient have been published ( 63 , 64 ). In the study of Quian et al ( 63 ), efficacy was observed in one of 2 treated patients, but no detail on treatment plan features was provided by the authors; moreover, 2 different pathways of preprocedural and follow-up exams were applied, which cannot be considered as being completely comparable.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Shoji et al ( 64 ), no acute or late effects were observed; nevertheless, the choice to select oncologic patients makes it more difficult to evaluate the endpoint of efficacy. Even if clinical efficacy on human subjects is difficult to be defined in a limited sample, fibrosis ( 63 , 64 ), or electrical block ( 64 ) was observed in the radio-ablated area in both studies. A similar finding, obtained by an MRI exam, was recorded in the case report ( 62 ).…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Franzetti

Volpe²,

Catto³

et al. 2022

Front. Cardiovasc. Med.

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AimThe purpose of this study is to collect available evidence on the feasibility and efficacy of stereotactic arrhythmia radio ablation (STAR), including both photon radiotherapy (XRT) and particle beam therapy (PBT), in the treatment of atrial fibrillation (AF), and to provide cardiologists and radiation oncologists with a practical overview on this topic.MethodsThree hundred and thirty-five articles were identified up to November 2021 according to preferred reporting items for systematic reviews and meta-analyses criteria; preclinical and clinical studies were included without data restrictions or language limitations. Selected works were analyzed for comparing target selection, treatment plan details, and the accelerator employed, addressing workup modalities, acute and long-term side-effects, and efficacy, defined either by the presence of scar or by the absence of AF recurrence.ResultsTwenty-one works published between 2010 and 2021 were included. Seventeen studies concerned XRT, three PBT, and one involved both. Nine studies (1 in silico and 8 in vivo; doses ranging from 15 to 40 Gy) comprised a total of 59 animals, 12 (8 in silico, 4 in vivo; doses ranging from 16 to 50 Gy) focused on humans, with 9 patients undergoing STAR: average follow-up duration was 5 and 6 months, respectively. Data analysis supported efficacy of the treatment in the preclinical setting, whereas in the context of clinical studies the main favorable finding consisted in the detection of electrical scar in 4/4 patients undergoing specific evaluation; the minimum dose for efficacy was 25 Gy in both humans and animals. No acute complication was recorded; severe side-effects related to the long-term were observed only for very high STAR doses in 2 animals. Significant variability was evidenced among studies in the definition of target volume and doses, and in the management of respiratory and cardiac target motion.ConclusionSTAR is an innovative non-invasive procedure already applied for experimental treatment of ventricular arrhythmias. Particular attention must be paid to safety, rather than efficacy of STAR, given the benign nature of AF. Uncertainties persist, mainly regarding the definition of the treatment plan and the role of the target motion. In this setting, more information about the toxicity profile of this new approach is compulsory before applying STAR to AF in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Franzetti

Volpe²,

Catto³

et al. 2022

Front. Cardiovasc. Med.

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“…The first STAR patient with VT was treated at Stanford University on a robotic radiosurgery system (CyberKnife ® , Accuray, Sunnyvale, CA, USA) in 2012 [2]. To date, there have been reported 68 patients treated with STAR (published data); 52 VT patients within clinical trials [4,[15][16][17][18][19][20]; 10 VT patients within clinical single-case series [21][22][23][24][25][26][27][28][29][30], and 6 AF patients [9,31,32]. Among treated VT patients, 34 have been treated with the Varian Linac system, and the rest of them have been treated with the Accuray CyberKnife system.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…A few other studies report VT recurrence >6 months after therapy in 7 of 15 evaluable patients [15,16,22]. For AF treatment, STAR demonstrated electrophysiological and histological effect to the left atrium [9,31,32]. Patients' follow-up, usually up to 12 months after STAR, was conducted on the basis of ECG monitoring and ICD interrogation.…”

Section: Assessment Of Treatment Efficacy and Safetymentioning

confidence: 99%

Stereotactic Arrhythmia Radioablation as a Novel Treatment Approach for Cardiac Arrhythmias: Facts and Limitations

et al. 2021

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Stereotactic ablative radiotherapy (SABR) is highly focused radiation therapy that targets well-demarcated, limited-volume malignant or benign tumors with high accuracy and precision using image guidance. Stereotactic arrhythmia radioablation (STAR) applies SABR to treat cardiac arrhythmias, including ventricular tachycardia (VT) and atrial fibrillation (AF), and has recently been a focus in research. Clinical studies have demonstrated electrophysiologic conduction blockade and histologic fibrosis after STAR, which provides a proof of principle for its potential for treating arrhythmias. This review will present the basic STAR principles, available clinical study outcomes, and how the technique has evolved since the first pre-clinical study. In addition to the clinical workflow, focus will be given on the process for stereotactic radiotherapy Quality Assurance (QA) tests, as well as the need for establishing a standardized QA protocol. Future implications and potential courses of research will also be discussed.

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The state‐of‐the‐art technic of stereotactic radioablation for the treatment of cardiac arrhythmias: An overview

MasoudKabir,

Bayani,

Mousavi Darzikolaee

et al. 2023

Health Science Reports

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IntroductionCardiac arrhythmias, including ventricular tachycardia (VT), stand as a significant threat to health, often leading to mortality and sudden cardiac death. While conventional treatments for VT exhibit efficacy, cases of refractory VT pose challenges. Stereotactic Arrhythmia Radioablation (STAR) offers a novel approach, delivering precise high‐dose radiation to well‐defined targets with minimal collateral damage. This study explores the potential of STAR as an alternative therapy, especially for high‐risk patients or those with refractory VT.MethodsThis research reviews ongoing studies and preliminary investigations into the evaluation of the efficacy and safety of STAR. The method involves targeted radiation delivery, assessing reductions in VT recurrence and the early safety profile in refractory VT patients. However, given STAR's early stage and limited clinical evidence, cautious interpretation is advised.ResultsPreliminary findings indicate a reduction in VT recurrence with STAR, suggesting promise as a therapeutic option. Early safety profiles are encouraging, but definitive statements on efficacy and safety require further investigation. Positive initial outcomes underscore the need for additional data and long‐term studies.ConclusionStereotactic Arrhythmia Radioablation is recently emerging as a promising treatment for refractory VT. While early results are encouraging, careful interpretation is needed, due to STAR's early stages. Ongoing investigations are critical for a comprehensive understanding of its long‐term efficacy and tolerability. This review provides fundamental insights into STAR's background, principles, pre‐treatment procedures, clinical implications, and toxicity, setting the stage for future research in this evolving therapeutic field.

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Advantages and challenges for noninvasive atrial fibrillation ablation

Cited by 10 publications

References 19 publications

Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Stereotactic Radiotherapy Ablation and Atrial Fibrillation: Technical Issues and Clinical Expectations Derived From a Systematic Review

Stereotactic Arrhythmia Radioablation as a Novel Treatment Approach for Cardiac Arrhythmias: Facts and Limitations

The state‐of‐the‐art technic of stereotactic radioablation for the treatment of cardiac arrhythmias: An overview

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