Analysis of Dose Distribution in the Heart for Radiosurgical Ablation of Atrial Fibrillation

Abstract

In a treatment planning study, radiosurgical treatment plans designed to produce lesions on the left atrium were created using two different methodologies. In one, structures in the heart (mitral valve and coronary arteries) were designated as critical structures while this was not done in the second plan. The treatment plans that were created were compared with standards for heart dose used when treating spine tumors. Although the dosage for the whole heart greatly exceeded the dose standards, when only the dose to the ventricles was considered, the plan where the mitral valve was spared was very close to the dose standards. The ventricles received a substantially higher dose in the plan where the mitral valve was not a critical structure. Although neither treatment plan was delivered, this study demonstrated the feasibility of treating the heart while minimizing dose to the ventricles.

Radiosurgery for ventricular tachycardia: preclinical and clinical evidence and study design for a German multi-center multi-platform feasibility trial (RAVENTA)

“…Finally, we added initial technical, pre-clinical, and clinical manuscripts not covered by the search based on our own experience in cardiac radiosurgery in the past 12 years. Evidence was finally extracted from the remaining 42 manuscripts, which include reports on two clinical trials [22,23], two clinical case series [24,25], eight case reports [19,20,[26][27][28][29][30][31], eight preclinical studies [18,[32][33][34][35][36][37][38][39], fourteen technical studies [40][41][42][43][44][45][46][47][48][49][50][51][52][53], and eight reviews or opinions [7,[54][55][56][57][58][59][60].…”

“…The authors found treatment effects for doses between 15 and 35 Gy during electrophysiology studies and gross pathological analysis [37]. Unfortunately, baseline and detailed histopathological data of those new treatments were not provided, while the dosimetry for some animals was presented elsewhere [46]. On the other hand, a more technically oriented publication by Gardner et al from the same animal studies showed that RA/CRS with carefully selected motion management can be delivered precisely to the heart (within 5-6% dose accuracy) using several implanted dosimeters [33].…”

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

“…Meanly treatment plans consisted of one single fraction and were delivered with CK in 2 cases ( 50 , 51 ). Conversely, in the other studies, a greater dose was planned with a CLA: 50 Gy in 5 fractions (10 Gy/fraction), according to the biological effective dose (BED) ( 52 , 53 ).…”

Investigating multi-leaf collimator tracking in stereotactic arrhythmic radioablation (STAR) treatments for atrial fibrillation

“…Technical advances in the past decade have broadened its applicability to see it become a suitable, and often popular, treatment option for previously challenging small and mobile tumours or non-oncologic pathologies. An emerging application is stereotactic arrhythmic radioablation (STAR) (Loo et al, 2015, Zei andSoltys, 2017) with preclinical animal studies (Blanck et al, 2014, Bode et al, 2015, Maguire et al, 2011, Sharma et al, 2010, Lehmann et al, 2016, treatment planning studies (Blanck et al, 2016, Ipsen et al, 2014, Xia et al, 2016, Gardner and Weidlich, 2016, and developing human clinical studies (Cvek et al, 2014, Loo et al, 2015, Zei and Soltys, 2017, Cuculich et al, 2017 suggesting that stereotactic radiosurgery could be an effective and safe treatment 10 for ventricular tachycardia and atrial fibrillation (AF).…”