Noninvasive stereotactic radioablation for the treatment of atrial fibrillation: First‐in‐man experience

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.Tweet: First-in-man treatment of atrial fibrillation using noninvasive stereotactic radioablation demonstrates feasibility. Abbreviations: AF, atrial fibrillation; AV, atrioventricular; CT, computed tomography; DOAC, direct oral anticoagulant; ECG, electrocardiogram; Gy, Gray; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; LV, left ventricle; MRI, magnetic resonance imaging; PA, posterior-anterior; pAF, paroxysmal atrial fibrillation; PTV, planned treatment volume; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; SBRT, stereotactic body radiation therapy; VT, ventricular tachycardia; WACA, wide-area circumferential ablation. AbstractPurpose: Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision. We evaluated the feasibility of stereotactic radioablation for treating paroxysmal AF. Methods:Two patients with drug-refractory paroxysmal AF underwent pulmonary vein isolation with SBRT. After placement of a percutaneous active fixation temporary pacing lead tracking fiducial, computed tomography (CT) angiography was performed to define left atrial anatomy. A tailored planning treatment volume was created to deliver contiguous linear ablations to isolate the pulmonary veins and posterior wall. Patients were treated on an outpatient basis in the radioablation suite.Clinical follow-up was performed through at least 24 months after therapy.Results: Both patients successfully underwent SBRT planning and treatment without significant early or long-term side effects up to 48 months of follow-up. One patient had AF recurrence after 6 months free of arrhythmia, while the second patient remains free of AF after 24 months with fibrosis detected on MRI scan consistent with the ablation lesion set. An incidentally noted small pericardial effusion occurred in one patient.Conclusion: Stereotactic radioablation may be feasible for the treatment of drugrefractory AF. Further evaluation is warranted. K E Y W O R D Sablation, atrial fibrillation, new technology, noninvasive ablation, radioablation, stereotactic

Feasibility Study on Stereotactic Radiotherapy for Total Pulmonary Vein Isolation in A Canine Model

“…Recently, Monroy et al and Qian et al reported the human experience of non-invasive stereotactic radioablation for the treatment of atrial fibrillation. 19 In this study, two patients with drugrefractory AF were treated with radiation with 25-Gy single fraction. Although they reported no procedure-related complications, inevitable exposure to critical structures, such as the esophagus, may have been a major concern because AF is generally not directly related to sudden death.…”

Review of Stereotactic Arrhythmia Radioablation Therapy for Cardiac Tachydysrhythmias

“…One patient had recurrence of atrial fibrillation (now persistent) after 6 months of follow-up; the other remained arrhythmia free after 2 years of follow-up. 49 Two case reports, Haskova et al 50 and Zeng et al, 51 lung changes consistent with radiation-induced pneumonitis. 27 These changes resolved by the 12 month follow-up examination.…”

“…48 The first report of STAR for pulmonary vein isolation for AF was published by Qian et al 2019. 49 Results from two ambulatory patients with paroxysmal atrial fibrillation despite ≥1 antiarrhythmic medications who had not previously undergone invasive catheter ablation were reported. An internal fiduciary marker was placed transvenously and attached to the interatrial septum for treatment planning and respiratory motion tracking.…”

Opportunities and perspectives of stereotactic radiosurgery for non-invasive arrhythmology interventions

“…У второго пациента за время наблюдения нарушений ритма не зафиксировано, весь период наблюдения принимался пропафенон (450 мг/сут). Отдаленных осложнений процедуры не отмечалось [24].…”