STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe

Grehn, Melanie; Mandija, Stefano; Miszczyk, Marcin; Krug, David; Tomasik, Bartłomiej; Stickney, Kristine; Alçântara, P.; Alongi, Filippo; Anselmino, Matteo; Salgado-Aranda, Ricardo; Balgobind, Brian V.; Boda-Heggemann, Judit; Boldt, Leif-Hendrik; Bottoni, Nicola; Cvek, Jakub; Eliçin, Olgun; Ferrari, Gaetano M. De; Hassink, Rutger J.; Hazelaar, Colien; Hindricks, Gerhard; Hurkmans, Coen; Iotti, Cinzia; Jadczyk, Tomasz; Jiravský, Otakar; Jumeau, R.; Kristiansen, Steen Buus; Levis, Mario; Algara, Manuel; Martí‐Almor, Julio; Mehrhof, Felix; Møller, D.S.; Molon, Giulio; Ouss, Alexandre; Peichl, Petr; Plášek, Jiří; Postema, Pieter G.; Quesada, Aurelio; Reichlin, Tobias; Rordorf, Roberto; Rudic, Boris; Saguner, Ardan M.; Bekke, Rachel M.A. ter; Torrecilla, J. López; Troost, Esther G.C.; Vitolo, Viviana; Andratschke, Nicolaus; Zeppenfeld, Katja; Blamek, Sławomir; Fast, Martin F.; Panfilis, Ludovica De; Blanck, Oliver; Pruvot, Étienne; Verhoeff, J.

doi:10.1093/europace/euac238

Cited by 26 publications

(19 citation statements)

References 55 publications

(88 reference statements)

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“…The classical workflow was thus emulated by providing the clinicians with the cardiac CT scan opened in the free MITK software. 4 Electro-anatomical data was rendered independently using VTK.…”

Section: Simulation Of a Classical Workflowmentioning

confidence: 99%

“…Cardiac radioablation (CR) recently appeared as a promising technique for treatment of refractory ventricular tachycardia (VT). [1][2][3] Also known as Stereotactic arrhythmia radiotherapy (STAR), 4 or cardiac stereotactic body radiotherapy (cardiac SBRT), 2 this treatment consists in delivering a high radiation dose (20 to 25Gy), in a single treatment session, to the myocardium tissues identified as the source of the VT. Patients suffering from VT undergo a series of treatments, including medications, implantation of an implantable cardioverter-defibrillator (ICD), and invasive catheter radiofrequency ablation (CRF), that constitutes the standard medical care.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiac radioablation (CR) recently appeared as a promising technique for treatment of refractory ventricular tachycardia (VT) 1–3 . Also known as Stereotactic arrhythmia radiotherapy (STAR), 4 or cardiac stereotactic body radiotherapy (cardiac SBRT), 2 this treatment consists in delivering a high radiation dose (20 to 25Gy), in a single treatment session, to the myocardium tissues identified as the source of the VT.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal fusion workflow for target delineation in cardiac radioablation of ventricular tachycardia

Rigal,

Benali,

Barré

et al. 2023

Medical Physics

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BackgroundCardiac radioablation (CR) is an innovative treatment to ablate cardiac arrythmia sources by radiation therapy. CR target delineation is a challenging task requiring the exploitation of highly different imaging modalities, including cardiac electro‐anatomical mapping (EAM).PurposeIn this work, a data integration process is proposed to alleviate the tediousness of CR target delineation by generating a fused representation of the heart, including all the information of interest resulting from the analysis and registration of electro‐anatomical data, PET scan and planning computed tomography (CT) scan. The proposed process was evaluated by cardiologists during delineation trials.MethodsThe data processing pipeline was composed of the following steps. The cardiac structures of interest were segmented from cardiac CT scans using a deep learning method. The EAM data was registered to the cardiac CT scan using a point cloud based registration method. The PET scan was registered using rigid image registration. The EAM and PET information, as well as the myocardium thickness, were projected on the surface of the 3D mesh of the left ventricle. The target was identified by delineating a path on this surface that was further projected to the thickness of the myocardium to create the target volume. This process was evaluated by comparison with a standard slice‐by‐slice delineation with mental EAM registration. Four cardiologists delineated targets for three patients using both methods. The variability of target volumes, and the ease of use of the proposed method, were evaluated.ResultsAll cardiologists reported being more confident and efficient using the proposed method. The inter‐clinician variability in delineated target volume was systematically lower with the proposed method (average dice score of 0.62 vs. 0.32 with a classical method). Delineation times were also improved.ConclusionsA data integration process was proposed and evaluated to fuse images of interest for CR target delineation. It effectively reduces the tediousness of CR target delineation, while improving inter‐clinician agreement on target volumes. This study is still to be confirmed by including more clinicians and patient data to the experiments.

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Section: Simulation Of a Classical Workflowmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimodal fusion workflow for target delineation in cardiac radioablation of ventricular tachycardia

Rigal,

Benali,

Barré

et al. 2023

Medical Physics

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“…Deep intramural areas or subepicardial locations, especially in the vicinity of structures such as coronary arteries, make effective ablation difficult which results in VT recurrence in about 20-50% of the patients. 125 Cardiac stereotactic body radiation therapy (SBRT), called STereotactic Arrhythmia Radioablation (STAR), is a promising new therapeutic modality for refractory VT patients without additional interventional options. 125 In a 2017 report of 5 patients who had 6577 episodes of VT in the 15 patient-months before treatment, after a 6-week blanking period, there were 4 episodes of VT post-STAR during the next 46 patient-months, a relative reduction of 99.9%.…”

Section: Stereotactic Arrhythmia Radioablationmentioning

confidence: 99%

Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm

Trohman

2023

J Intensive Care Med

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Electrical storm (ES) is characterized by three or more discrete sustained ventricular tachyarrhythmia episodes occurring within a limited time frame (generally ≤ 24 h) or an incessant ventricular tachyarrhythmia lasting > 12 h. In patients with an implantable cardioverterdefibrillator (ICD), ES is defined as three or more appropriate device therapies, separated from each other by at least 5 min, which occur within a 24-h period. ES may constitute a medical emergency, depending on the number arrhythmic episodes, their duration, the type, and the cycle length of the ventricular arrhythmias, as well as the underlying ventricular function. This narrative review was facilitated by a search of MEDLINE to identify peer-reviewed clinical trials, randomized controlled trials, meta-analyses, and other clinically relevant studies. The search was limited to English-language reports published between 1999 and 2023. ES was searched using the terms mechanisms, genetics, channelopathies, management, pharmacological therapy, sedation, neuraxial modulation, cardiac sympathetic denervation, ICDs, and structural heart disease. Google and Google scholar as well as bibliographies of identified articles were reviewed for additional references. This manuscript examines the current strategies available to treat ES and compares pharmacological and invasive treatment strategies to diminish ES recurrence, morbidity, and mortality.

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“…Currently, several prospective clinical trials aimed at investigation of short- and long-term morbidity and procedure-related side effects as well as treatment efficacy have been implemented. In Europe, the STOPSTORM consortium aims to collect data regarding efficacy and safety in a large and broad VT patient population treated by multiple centers on various treatment platforms [ 11 ]. In many of these studies, patients with LVAD are excluded.…”

Section: Introductionmentioning

confidence: 99%

Cardiac radioablation of incessant ventricular tachycardia in patients with terminal heart failure under permanent left ventricular assist device therapy—description of two cases

et al. 2023

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Purpose Cardiac radioablation (cRA) using a stereotactic single-session radioablative approach has recently been described as a possible treatment option for patients with otherwise untreatable recurrent ventricular tachycardia (VT). There is very limited experience in cRA for patients undergoing left ventricular assist device (LVAD) therapy. We present clinical experiences of two patients treated with cRA for incessant VT under long-term LVAD therapy. Methods Two male patients (54 and 61 years old) with terminal heart failure under LVAD therapy (both patients for 8 years) showed incessant VT despite extensive antiarrhythmic drug therapy and repeated catheter ablation. cRA with a single dose of 25 Gy was applied as a last resort strategy under compassionate use in both patients following an electroanatomical mapping procedure. Results Both patients displayed ongoing VT during and after the cRA procedure. Repeated attempts at post-procedural rhythm conversion failed in both patients; however, one patient was hemodynamically stabilized and could be discharged home for several months before falling prey to a fatal bleeding complication. The second patient initially stabilized for a few days following cRA before renewed acceleration of running VT required bilateral ablation of the stellate ganglion; the patient died 50 days later. No immediate side effects of cRA were detected in either patient. Conclusion cRA might serve as a last resort strategy for patients with terminal heart failure undergoing LVAD therapy and displaying incessant VT. Intermediate- and long-term outcomes of these seriously ill patients often remain poor; therefore, best supportive care strategies should also be evaluated as long as no clear beneficial effects of cRA procedures can be shown. For patients treated with cRA under running ventricular rhythm abnormality, strategies for post-procedural generation of stabilized rhythm have to be established.

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STereotactic Arrhythmia Radioablation (STAR): the Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary consortium (STOPSTORM.eu) and review of current patterns of STAR practice in Europe

Cited by 26 publications

References 55 publications

Multimodal fusion workflow for target delineation in cardiac radioablation of ventricular tachycardia

Multimodal fusion workflow for target delineation in cardiac radioablation of ventricular tachycardia

Etiologies, Mechanisms, Management, and Outcomes of Electrical Storm

Cardiac radioablation of incessant ventricular tachycardia in patients with terminal heart failure under permanent left ventricular assist device therapy—description of two cases

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