Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Narducci, Maria Lucia; Cellini, Francesco; Placidi, L.; Boldrini, Luca; Perna, Francesco; Bencardino, Gianluigi; Pinnacchio, Gaetano; Bertolini, R; Cannelli, G; Frascino, V.; Tagliaferri, Luca; Chiesa, S.; Mattiucci, Gian Carlo; Boccadoro, Mario; Gambacorta, Maria Antonietta; Rossi, Marco; Indovina, Luca; Pelargonio, Gemma; Valentini, Vincenzo; Crea, Filippo

doi:10.3389/fcvm.2020.565471

Cited by 5 publications

(2 citation statements)

References 22 publications

(36 reference statements)

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“…Concerning the optimal compensation for cardiorespiratory movements of the thoracic targets and the reduction of the uncertainties related to patients' positioning, different methods have been proposed, including indirect cardiorespiratory tracking using fiducial markers such as the ICD lead ( 27 , 28 ), optical surface monitoring system for continuous intrafraction positioning tracking ( 39 ), respiratory gating ( 29 , 32 ) and even MRI-based cardiac gating ( 40 ). Considering the small number of patients treated with STAR and the heterogeneity of the local delivery platform and facilities, the benefit and the feasibility of each method are under evaluation.…”

Section: Discussionmentioning

confidence: 99%

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Levis

Dusi

Magnano

et al. 2022

Front. Cardiovasc. Med.

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IntroductionCatheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation.Case presentationWe hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis.ConclusionOur case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile.

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Section: Discussionmentioning

confidence: 99%

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Levis

Dusi

Magnano

et al. 2022

Front. Cardiovasc. Med.

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“…negative pressure membranes or abdominal-pressure plates, which represent a significant challenge to patients. Another option might be to use a vacuum bag alone and expose the patient's body surface for OSI to enable the monitoring of surface movement in real time (7). To account for the movement of the GTV, which is affected by heart rhythm and respiratory motion, we collected CCTA and r4DCT sequences and used them to reconstruct pCT and imageguided reference images.…”

Section: A B Cmentioning

confidence: 99%

Stereotactic arrhythmia radiotherapy: a case study of real-time image-guided noninvasive treatment for ventricular tachycardia

Li¹,

Chen²,

Guangjun³

et al. 2022

Quant Imaging Med Surg

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Ventricular tachycardia ablation through radiation therapy (VT-ART) consortium: Concept description of an observational multicentric trial via matched pair analysis

Cellini

Narducci²,

Pavone³

et al. 2023

Front. Cardiovasc. Med.

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IntroductionMonomorphic ventricular tachycardia (VT) is a life-threatening condition often observed in patients with structural heart disease. Ventricular tachycardia ablation through radiation therapy (VT-ART) for sustained monomorphic ventricular tachycardia seems promising, effective, and safe. VT-ART delivers focused, high-dose radiation, usually in a single fraction of 25 Gy, allowing ablation of VT by inducing myocardial scars. The procedure is fully non-invasive; therefore, it can be easily performed in patients with contraindications to invasive ablation procedures. Definitive data are lacking, and no direct comparison with standard procedures is available.DiscussionThe aim of this multicenter observational study is to evaluate the efficacy and safety of VT-ART, comparing the clinical outcome of patients undergone to VT-ART to patients not having received such a procedure. The two groups will not be collected by direct, prospective accrual to avoid randomization among the innovative and traditional arm: A retrospective selection through matched pair analysis will collect patients presenting features similar to the ones undergone VT-ART within the consortium (in each center independently). Our trial will enroll patients with optimized medical therapy in whom endocardial and/or epicardial radiofrequency ablation (RFA), the gold standard for VT ablation, is either unfeasible or fails to control VT recurrence. Our primary outcome is investigating the difference in overall cardiovascular survival among the group undergoing VT-ART and the one not exposed to the innovative procedure. The secondary outcome is evaluating the difference in ventricular event-free survival after the last procedure (i.e., last RFA vs. VT-ART) between the two groups. An additional secondary aim is to evaluate the reduction in the number of VT episodes comparing the 3 months before the procedure to the ones recorded at 6 months (from the 4th to 6th month) following VT-ART and RFA, respectively. Other secondary objectives include identifying the benefits of VT-ART on cardiac function, as evaluated through an electrocardiogram, echocardiographic, biochemical variables, and on patient quality of life. We calculated the sample size (in a 2:1 ratio) upon enrolling 149 patients: 100 in the non-exposed control group and 49 in the VT-ART group. Progressively, on a multicentric basis supervised by the promoting center in the VT-ART consortium, for each VT-ART patient enrollment, a matched pair patient profile according to the predefined features will be shared with the consortium to enroll a patient that has not undergone VT-ART.ConclusionOur trial will provide insight into the efficacy and safety of VT-ART through a matched pair analysis, via an observational, multicentric study of two groups of patients with or without VT-ART in the multicentric consortium (with subgroup stratification into dynamic cohorts).

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Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter- and Intra-fractional Image Guidance

Cited by 5 publications

References 22 publications

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

Stereotactic arrhythmia radiotherapy: a case study of real-time image-guided noninvasive treatment for ventricular tachycardia

Ventricular tachycardia ablation through radiation therapy (VT-ART) consortium: Concept description of an observational multicentric trial via matched pair analysis

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