Stereotactic Arrhythmia Radioablation for Ventricular Tachycardia: Single Center First Experiences

Gerard, Ian J.; Bernier, Martin; Hijal, Tarek; Kopek, Neil; Pater, Piotr; Stosky, Jordan; Stroian, G.; Toscani, Bruno; Alfieri, Joanne

doi:10.1016/j.adro.2021.100702

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Although clinical and preclinical reports and inferred working mechanisms indicate a longer time to effect a result, 2 the direct clinical effects we observed are in line with several previous reports of patients with VT storm and incessant VF. 4 , 5 , 6 , 7 These reports also showed direct clinical effects in reducing the (short-term) arrhythmia burden combined with promising safety results. 4 , 5 , 6 , 7 Therefore, we believe there could be a role for cardiac radioablation in patients with VT storm when conventional therapy fails, although more data are necessary to confirm these results.…”

Section: Discussionmentioning

confidence: 94%

“… 4 , 5 , 6 , 7 These reports also showed direct clinical effects in reducing the (short-term) arrhythmia burden combined with promising safety results. 4 , 5 , 6 , 7 Therefore, we believe there could be a role for cardiac radioablation in patients with VT storm when conventional therapy fails, although more data are necessary to confirm these results.…”

Section: Discussionmentioning

confidence: 94%

“… 2 , 3 Therefore, it is unknown whether cardiac radioablation is a suitable therapy in the setting of VT storm and incessant VT, although cases have been reported. 4 , 5 , 6 , 7 In this report, we present a patient with therapy-refractory VT storm and incessant VT who experienced direct clinical effects of cardiac radioablation.…”

Section: Introductionmentioning

confidence: 97%

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Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

Ree

Dieleman

Visser

et al. 2022

Advances in Radiation Oncology

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 94%

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Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

Ree

Dieleman

Visser

et al. 2022

Advances in Radiation Oncology

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“…These direct effects have also previously been observed. 12 , 31–35 Usually, VT recurred within the first 4 months after treatment whilst patients were on lower but still substantial doses of anti-arrhythmic drugs. Interestingly, no VT occurred in the subsequent 5 months until reaching a second peak of recurrences after 9 months.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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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.

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“…[20][21][22] Reducing abdomi-nal organ motion is possible with AC (such as for the liver); however, it has yet to be evaluated for its effect on stomach motion relative to STAR target locations. Gerard et al 18 notably did not employ AC for their singlepatient case study of ventricular radioablation because the stomach was brought closer to the PTV under AC. It is unknown whether AC causes this effect for each patient and to what extent.…”

Section: Introductionmentioning

confidence: 99%

Impact of abdominal compression on heart and stomach motion for stereotactic arrhythmia radioablation

Cecchi,

Ploquin,

Faruqi

et al. 2024

J Applied Clin Med Phys

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PurposeTo evaluate the effectiveness of abdominal compression (AC) as a respiratory motion management method for the heart and stomach during stereotactic arrhythmia radioablation (STAR).Methods4D computed tomography (4DCT) scans of patients imaged with AC or without AC (free‐breathing: FB) were obtained from ventricular‐tachycardia (VT) (n = 3), lung cancer (n = 18), and liver cancer (n = 18) patients. Patients treated for VT were imaged both FB and with AC. Lung and liver patients were imaged once with FB or with AC, respectively. The heart, left ventricle (LV), LV components (LVCs), and stomach were contoured on each phase of the 4DCTs. Centre of mass (COM) translations in the left/right (LR), ant/post (AP), and sup/inf (SI) directions were measured for each structure. Minimum distances between LVCs and the stomach over the respiratory cycle were also measured on each 4DCT phase. Mann‐Whitney U‐tests were performed between AC and FB datasets with a significance of α = 0.05.ResultsNo statistical difference (all p values were >0.05) was found in COM translations between FB and AC patient datasets for all contoured cardiac structures. A reduction in COM translation with AC relative to FB was patient, direction, and structure specific for the three VT patients. A significant decrease in the AP range of motion of the stomach was observed under AC compared to FB. No statistical difference was found between minimum distances to the stomach and LVCs between FB and AC.ConclusionsAC was not a consistent motion management method for STAR, nor does not uniformly affect the separation distance between LVCs and the stomach. If AC is employed in future STAR protocols, the motion of the target volume and its relative distance to the stomach should be compared on two 4DCTs: one while the patient is FB and one under AC.

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Stereotactic Arrhythmia Radioablation for Ventricular Tachycardia: Single Center First Experiences

Cited by 7 publications

References 20 publications

Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy-Refractory Ventricular Tachycardia Storm

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

Impact of abdominal compression on heart and stomach motion for stereotactic arrhythmia radioablation

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