Non-invasive stereotactic arrhythmia radiotherapy for ventricular tachycardia: results of the prospective STARNL-1 trial

Abstract

Aims Stereotactic arrhythmia radiotherapy (STAR) is suggested as potentially effective and safe treatment for patients with therapy-refractory ventricular tachycardia (VT). However, the current prospective knowledge base and experience with STAR is limited. In this study we aimed to prospectively evaluate the efficacy and safety of STAR. Methods and results The StereoTactic Arrhythmia Radiotherapy in the Netherlands no.1 was a pre-post intervention study to prospectively evaluate efficacy and safety of STAR. In patients with therapy-refractory VT, the pro-arrhythmic region was treated with a 25 Gy single radiotherapy fraction. The main efficacy measure was a reduction in the number of treated VT-episodes by ≥50%, comparing the 12 months before and after treatment (or end of follow-up, excluding a 6-week blanking period). The study was deemed positive when ≥50% of patients would meet this criterion. Safety evaluation included left ventricular ejection fraction, pulmonary function, and adverse events. Six male patients with an ischaemic cardiomyopathy were enrolled, and median age was 73 years (range 54–83). Median left ventricular ejection fraction was 38% (range 24–52). The median planning target volume was 187 mL (range 93–372). Four (67%) patients completed the 12-month follow-up, and two patients died (not STAR related) during follow-up. The main efficacy measure of ≥50% reduction in treated VT-episodes at the end of follow-up was achieved in four patients (67%). The median number of treated VT-episodes was reduced by 87%. No reduction in left ventricular ejection fraction or pulmonary function was observed. No treatment related serious adverse events occurred. Conclusions STAR resulted in a ≥ 50% reduction in treated VT-episodes in 4/6 (67%) patients. No reduction in cardiac and pulmonary function nor treatment-related serious adverse events were observed during follow-up. Clinical trial registration Netherlands Trial Register—NL7510.

Ventricular Tachycardia Catheter Ablation: Retrospective Analysis and Prospective Outlooks—A Comprehensive Review

“…It was first introduced in 2012 [96] as a treatment for patients with frequent VT recurrences after catheter ablation and appropriate antiarrhythmic treatment and showed promising short-term results [96][97][98][99][100][101][102][103][104], although further recurrences proved to be quite frequent [105][106][107].…”

Twenty-five years of catheter ablation of ventricular tachycardia: a look back and a look forward

“…During the follow-up period, no treatment-related serious adverse events were observed. 15 In addition, scientists have also proposed the use of proton beams, carbon beams, and other energies for VT ablation, 16 but these non-invasive VT ablation methods require further studies on the long-term efficacy and potential effects of radiation on the heart and adjacent organs are still under investigation. Pulsed field ablation (PFA) is a novel, non-thermal modality by irreversibly electroporating cell membranes, which can spare collateral tissues damage.…”

Cardiac Arrhythmias in Patients Treated for Lung Cancer: A Review

“…Meta-analysis of seven observational studies with a total of 61 patients showed that six months after STAR, the VT burden reduction was 92%, accompanied with an 86% reduction in the number of ICD shocks [62]. Several small prospective trials were recently published [63][64][65][66][67]. These studies primarily focused on safety and indicated that STAR has acceptable short-term toxicity with no significant concerns regarding acute cardiac toxicity.…”