Safety and Efficacy of Stereotactic Arrhythmia Radioablation for the Treatment of Ventricular Tachycardia: A Systematic Review

Volpato, Giovanni; Compagnucci, Paolo; Cipolletta, Laura; Parisi, Quintino; Valeri, Yari; Carboni, Laura; Giovagnoni, Andrea; Russo, Antonio Dello; Casella, Michela

doi:10.3389/fcvm.2022.870001

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…In patients with refractory VT, the role of stereotactic arrhythmia radioablation (STAR) should be discussed as a potential alternative. 14 Due to the lack of evidence on the acute effectiveness of STAR in stabilizing patients with recurrent electrical storm in the setting of LV thrombus when the patient presented, this option was not considered.…”

Section: Discussionmentioning

confidence: 99%

Surgical ventricular reconstruction and intraoperative cryoablation in a patient with drug-refractory ventricular tachycardia and left ventricular thrombus: a case report

Lopez,

Vogler,

Aboud

et al. 2024

European Heart Journal - Case Reports

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Background Despite modern techniques for ablation of ventricular tachycardia (VT), the procedure faces challenges such as deep intramural substrates or inaccessibility of the pericardial space. We aim to present a case of successful surgical treatment of a patient with drug-refractory VT, an apical aneurysm, large left ventricular (LV) thrombus, and recurrent implantable cardioverter defibrillator (ICD) shocks following failed epicardial catheter ablation. Case summary A 67-year-old male with a history of ischaemic cardiomyopathy was brought to the emergency room after a syncope because of VT. The VT was terminated by an external cardioversion prior to admission. The ICD interrogation showed an episode of sustained monomorphic VT with eight appropriate but mostly ineffective ICD shocks. An echocardiogram revealed an apical aneurysm with a thrombus. Anticoagulation and antiarrhythmic drug therapy were initiated. Days later, the patient suffered recurrent episodes of sustained VTs, refractory to pharmacological therapy, and epicardial ablation; therefore, following aneurysmectomy and thrombus removal, a reconstruction of the LV and surgical endocardial cryoablation were performed. In addition, ICD extraction was done due to recurrent bacteraemia with Staphylococcus aureus. A subcutaneous ICD was later implanted. After surgery, the patient remained free of any VT episodes during 44 months of follow-up. Conclusion Combined surgical ventricular reconstruction and intraoperative cryoablation may be considered as an alternative, highly effective therapy in patients with drug-refractory VTs in the setting of a LV thrombus.

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Section: Discussionmentioning

confidence: 99%

Surgical ventricular reconstruction and intraoperative cryoablation in a patient with drug-refractory ventricular tachycardia and left ventricular thrombus: a case report

Lopez,

Vogler,

Aboud

et al. 2024

European Heart Journal - Case Reports

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“…Stereotactic radiotherapy (or STAR, STereotactic Arrythmias Radioablation) is a new anti-arrhythmic treatment option based on the non-invasive administration of a single fraction, high-dose radiotherapy (RT) to a relatively small cardiac volume, 27 derived from the established oncological approach. STAR may potentially overcome one of the main limitations of conventional VT ablation associated with recurrence, i.e.…”

Section: Sub-acute/chronic Phasementioning

confidence: 99%

Electrical storm management in structural heart disease

Dusi

Angelini

Gravinese

et al. 2023

European Heart Journal Supplements

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Electrical storm (ES) is a life-threatening condition characterized by at least three separate episodes of ventricular arrhythmias (VAs) over 24 h, each requiring therapeutic intervention, including implantable cardioverter defibrillator (ICD) therapies. Patients with ICDs in secondary prevention are at higher risk of ES and the most common presentation is that of scar-related monomorphic VAs. Electrical storm represents a major unfavourable prognostic marker in the history of patients with structural heart disease, with an associated two- to five-fold increase in mortality, heart transplant, and heart failure hospitalization. Early recognition and prompt treatment are crucial to improve the outcome. Yet, ES management is complex and requires a multidisciplinary approach and well-defined protocols and networks to guarantee a proper patient care. Acute phase stabilization should include a comprehensive clinical assessment, resuscitation and sedation management skills, ICD reprogramming, and acute sympathetic modulation, while the sub-acute/chronic phase requires a comprehensive heart team evaluation to define the better treatment option according to the haemodynamic and overall patient’s condition and the type of VAs. Advanced anti-arrhythmic strategies, not mutually exclusive, include invasive ablation, cardiac sympathetic denervation, and, for very selected cases, stereotactic ablation. Each of these aspects, as well as the new European Society of Cardiology guidelines recommendations, will be discussed in the present review.

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“…The use of STAR in humans was first described in a 2015 report by Loo et al, in which the technique successfully controlled ventricular tachycardia (VT) episodes in a 71-year-old male patient with ischemic cardiomyopathy, severely reduced ejection fraction, and oxygen-dependent chronic obstructive pulmonary disease [33]. Despite its relatively recent introduction, several studies have been conducted to date, enrolling approximately a total of a hundred patients, and providing guidance for the informed management of patients [11,65]. The main completed/ongoing studies on STAR are resumed in Table 3.…”

Section: Previous Experiences and Ongoing Studiesmentioning

confidence: 99%

“…STAR is a minimally invasive procedure that is typically performed under conscious sedation. Patients typically return home the same day as the procedure, with a relatively short recovery period [11]. Hence, STAR represents an attractive alternative for patients with recurrent VT.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

Guarracini

Tritto

Monaco

et al. 2023

JCDD

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Ventricular tachycardia in patients with structural heart disease is a significant cause of morbidity and mortality. According to current guidelines, cardioverter defibrillator implantation, antiarrhythmic drugs, and catheter ablation are established therapies in the management of ventricular arrhythmias but their efficacy is limited in some cases. Sustained ventricular tachycardia can be terminated by cardioverter-defibrillator therapies although shocks in particular have been demonstrated to increase mortality and worsen patients’ quality of life. Antiarrhythmic drugs have important side effects and relatively low efficacy, while catheter ablation, even if it is actually an established treatment, is an invasive procedure with intrinsic procedural risks and is frequently affected by patients’ hemodynamic instability. Stereotactic arrhythmia radioablation for ventricular arrhythmias was developed as bail-out therapy in patients unresponsive to traditional treatments. Radiotherapy has been mainly applied in the oncological field, but new current perspectives have developed in the field of ventricular arrhythmias. Stereotactic arrhythmia radioablation provides an alternative non-invasive and painless therapeutic strategy for the treatment of previously detected cardiac arrhythmic substrate by three-dimensional intracardiac mapping or different tools. Since preliminary experiences have been reported, several retrospective studies, registries, and case reports have been published in the literature. Although, for now, stereotactic arrhythmia radioablation is considered an alternative palliative treatment for patients with refractory ventricular tachycardia and no other therapeutic options, this research field is currently extremely promising.

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Safety and Efficacy of Stereotactic Arrhythmia Radioablation for the Treatment of Ventricular Tachycardia: A Systematic Review

Cited by 4 publications

References 34 publications

Surgical ventricular reconstruction and intraoperative cryoablation in a patient with drug-refractory ventricular tachycardia and left ventricular thrombus: a case report

Surgical ventricular reconstruction and intraoperative cryoablation in a patient with drug-refractory ventricular tachycardia and left ventricular thrombus: a case report

Electrical storm management in structural heart disease

Stereotactic Arrhythmia Radioablation Treatment of Ventricular Tachycardia: Current Technology and Evolving Indications

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