Review of Stereotactic Arrhythmia Radioablation Therapy for Cardiac Tachydysrhythmias

Chiu, Michael; Mitchell, L. Brent; Ploquin, Nicolas; Faruqi, Salman; Kuriachan, Vikas

doi:10.1016/j.cjco.2020.11.006

Cited by 9 publications

(10 citation statements)

References 57 publications

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“…Identifying the locations of AF mechanisms in the whole heart could enable the spatial targeting of ablation, surgical therapy, pacing, or novel modalities such as external beam irradiation [ 75 ]. The recent Early Treatment of Atrial Fibrillation for Stroke Prevention Trial (EAST) Atrial Fibrillation Network (AFNET)-4 trial showed that the early maintenance of sinus rhythm reduces major adverse events [ 76 ].…”

Section: Af Pathophysiology Within the Heartmentioning

confidence: 99%

Identifying Atrial Fibrillation Mechanisms for Personalized Medicine

Deb

Ganesan

Feng

et al. 2021

JCM

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Atrial fibrillation (AF) is a major cause of heart failure and stroke. The early maintenance of sinus rhythm has been shown to reduce major cardiovascular endpoints, yet is difficult to achieve. For instance, it is unclear how discoveries at the genetic and cellular level can be used to tailor pharmacotherapy. For non-pharmacologic therapy, pulmonary vein isolation (PVI) remains the cornerstone of rhythm control, yet has suboptimal success. Improving these therapies will likely require a multifaceted approach that personalizes therapy based on mechanisms measured in individuals across biological scales. We review AF mechanisms from cell-to-organ-to-patient from this perspective of personalized medicine, linking them to potential clinical indices and biomarkers, and discuss how these data could influence therapy. We conclude by describing approaches to improve ablation, including the emergence of several mapping systems that are in use today.

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Section: Af Pathophysiology Within the Heartmentioning

confidence: 99%

Identifying Atrial Fibrillation Mechanisms for Personalized Medicine

Deb

Ganesan

Feng

et al. 2021

JCM

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“…In addition, specific DVC guidelines were published in particular clinical settings, such as Hodgkin’s lymphomas [ 11 ], breast carcinomas [ 12 , 13 , 14 ], and pediatric cancers [ 15 , 16 , 17 , 18 , 19 , 20 ]. Finally, in the last few years, in parallel with the introduction of stereotactic ablative RT of ventricular arrythmia (STAR) [ 21 , 22 , 23 ], specific DVCs for this treatment were also proposed [ 6 , 8 , 21 , 22 , 24 ]. Therefore, a large number of guidelines or recommendations is now available to guide RT prescription and treatment plan evaluation and comparison.…”

Section: Introductionmentioning

confidence: 99%

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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Background: The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. Material and Methods: A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin’s lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. Results: Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. Conclusions: A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.

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“…Noninvasive stereotactic body radioablation therapy (SBRT) has emerged as a novel therapeutic option for ventricular tachycardia (VT) refractory or ineligible to antiarrhythmic drugs and catheter-ablation [1][2][3]. Stereotactic radiotherapy is a radiotherapy technique that allows accurate high doses of radiation to be delivered to targeted tissue with minimal exposure to surrounding anatomic structures.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

Aras

Çetin

Ozturk

et al. 2022

J Interv Card Electrophysiol

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Background Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients’ procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT’s efficacy as well as the value of using a blanking period following a SBRT session. Methods Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area. Results During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Conclusions Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.

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Review of Stereotactic Arrhythmia Radioablation Therapy for Cardiac Tachydysrhythmias

Cited by 9 publications

References 57 publications

Identifying Atrial Fibrillation Mechanisms for Personalized Medicine

Identifying Atrial Fibrillation Mechanisms for Personalized Medicine

Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia

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