Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)—A Comprehensive Review

Miszczyk, Marcin; Jadczyk, Tomasz; Gołba, Krzysztof S.; Wojakowski, Wojciech; Wita, Krystian; Bednarek, Jacek; Blamek, Sławomir

doi:10.3390/jcm10061238

Cited by 27 publications

(20 citation statements)

References 53 publications

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“…However, to date the entire literature describes less than 60 patients treated by this novel approach. [11][12][13] Recognising the urgent need for more effective treatments in patients with refractory VT, three UK tertiary cardiac centres agreed to collaborate in developing cardiac SABR services aiming to maximise the benefits of combined experience of a novel technique. We now report our initial experiences.…”

Section: Key Questionsmentioning

confidence: 99%

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

et al. 2021

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BackgroundOptions for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option.MethodsSeven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used.ResultsAcute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure.ConclusionsCardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.

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Section: Key Questionsmentioning

confidence: 99%

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

et al. 2021

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“…It has been shown to reduce the VT burden in patients who are difficult to treat with medication and/or catheter ablation or cannot tolerate catheter ablation [75]. However, there are significant differences in this emerging treatment between studies including a significant lack of consistency in the treatment protocols [76]. Therefore, more RCTs are still needed to establish a detailed treatment strategy.…”

Section: Radiofrequency Catheter Ablationmentioning

confidence: 99%

Sudden cardiac death in patients with myocardial infarction: 1.5 primary prevention

Feng¹,

Feng²

2021

Reviews in Cardiovascular Medicine

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Sudden cardiac death (SCD) is one of the most common causes of death in the world. Coronary heart disease (CHD) is the root cause of most patients with SCD, and myocardial infarction (MI) is the main cause of SCD among all types of CHD. Early identification of high-risk patients after an MI, and the application of related prevention strategies and disease-specific treatments will be the key to reduce SCD. The mechanism of SCD after MI varies over time, and the relevant risk prediction indicators are also dynamic and different. In the existing guidelines for MI patients, the static and slightly single stratification of primary (PP) and secondary (SP) prevention has significant room for improvement. The 1.5 primary prevention (1.5PP) is defined as patients with PP who also had the following risk factors: non-sustained ventricular tachycardia (NSVT), frequent premature ventricular contractions (PVCs), severe heart failure (left ventricular ejection fraction, LVEF <25%), and syncope or pre-syncope. The emergence of 1.5PP has provided a new method for the stratification and management of SCD after an MI.

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“…To no surprise, the first case reports on STAR ( 4 – 6 ) and encouraging results of the phase I/II study by Robinson et al ( 7 ) have met with avid interest, resulting in multiple centers adopting the method as compassionate treatment and within new prospective clinical trials ( 8 ). One of them is the Polish trial SMART-VT ( ClinicalTrials.gov Identifier: NCT04642963) ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Radiosurgery in Treatment of Ventricular Tachycardia – Initial Experience Within the Polish SMART-VT Trial

Kurzelowski

Latusek

Miszczyk

et al. 2022

Front. Cardiovasc. Med.

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BackgroundStereotactic Arrhythmia Radioablation (STAR) is an emerging treatment modality for patients with sustained ventricular tachycardia (VT) and refractory to treatment with drugs and radiofrequency catheter ablation (RFA). It is believed that up to 12–17% of patients experience recurrence of VT within 1 year of follow-up; thus, novel therapeutic options are needed. The aim of this article is to present initial experience within a novel treatment modality for VT.Case SummaryTwo patients with a medical history of coronary artery disease and heart failure with reduced left ventricle (LV) ejection fraction, after implantation of cardioverter-defibrillator (ICD) and previous unsuccessful RFAs owing to sustained VT were admitted to the cardiology department due to recurrence of sustained VT episodes. With electroanatomical mapping (EAM), the VT substrate in LV has been confirmed and specified. In order to determine the target volume for radioablation, contrast-enhanced computed tomography was performed and the arrhythmia substrate was contoured using EAM data. Using the Volumetric Modulated Arc Therapy technique and three 6 MeV flattening filter-free photon beam fields, a single dose of 25 Gy was delivered to the target volume structure located in the apex and anterior apical segments of LV in the first patient and in the apex, anterolateral and inferior apical segments of the second patient. In both cases, volumes of the target structures were comparable. Interrogation of the implanted ICD at follow-up visits throughout 6 months after the treatment revealed no VT episodes in the first patient and sudden periprocedural increase in VT burden with a subsequent gradual decrease of ventricular arrhythmia to only two non-sustained episodes at the end of the follow-up period in case of the second patient. A significant reduction in premature ventricular contractions burden was observed compared to the pre-treatment period. No noticeable deterioration in LV function was noted, nor any adverse effects of radiosurgery associated with the implanted device.ConclusionThe early response to STAR can be unpredictable and probably does not reflect the final outcome of irradiation. Close monitoring of patients, especially in the early period after irradiation is crucial to properly handle potentially harmful early reactions to STAR.

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Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)—A Comprehensive Review

Cited by 27 publications

References 53 publications

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

Sudden cardiac death in patients with myocardial infarction: 1.5 primary prevention

Radiosurgery in Treatment of Ventricular Tachycardia – Initial Experience Within the Polish SMART-VT Trial

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