Stereotactic Radiotherapy for the Management of Refractory Ventricular Tachycardia: Promise and Future Directions

Abstract

Ventricular tachycardia (VT) caused by myocardial scaring bears a significant risk of mortality and morbidity. Antiarrhythmic drug therapy (AAD) and catheter ablation remain the cornerstone of VT management, but both treatments have limited efficacy and potential adverse effects. Stereotactic body radiotherapy (SBRT) is routinely used in oncology to treat non-invasively solid tumors with high precision and efficacy. Recently, this technology has been evaluated for the treatment of VT. This review presents the basic underlying principles, proof of concept, and main results of trials and case series that used SBRT for the treatment of VT refractory to AAD and catheter ablation.

Use of Stereotactic Radioablation Therapy as a Bailout Therapy for Refractory Ventricular Tachycardia in a Patient with a No-entry Left Ventricle

“…Mechanical prosthetic aortic and mitral valves impede either a retrograde aortic or transseptal approach to the LV endocardium. SBRT, delivered in a single dose of 25 Gy, may serve as an alternative or palliative therapy for otherwise untreatable patients with refractory VT and electrical storm who are otherwise ineligible for catheter ablation, 6 , 11 – 13 potentially keeping ventricular arrhythmias quiescent while awaiting heart transplantation, 14 as was done in the current case. Because of its high precision and target conformity, it can deliver a high dose of radiation to a specific area in tissue without significantly affecting the nearby tissues.…”

Paroxysmal Atrial Fibrillation in Elderly: Worldwide Preliminary Data of LINAC-Based Stereotactic Arrhythmia Radioablation Prospective Phase II Trial

“…In terms of TT, Cyberknife device is mounted on a robotic arm to deliver radiation to a tumor from different trajectories, while LINAC with a rotation of its gantry deliver high dose of radiation in a shorter time (3 vs. 90 min) ( 12 ). However, the shorter time is essential for reducing intrafraction motion, so in the present trial, due to the motion study and IGRT/SGRT monitoring, the introduction of fiducial was not necessary ( 3 – 5 , 12 ).…”

“…However, previous studies reported STAR related complications during ventricular tachycardia treatment. In particular, a low percentage of complications was reported mainly within 90 days from STAR (heart failure exacerbation, radiation pericarditis and pneumonitis, nausea) and at long term follow up (mitral valve regurgitation worsening, pericardial effusions and gastro-pericardial fistula) ( 12 ).…”

A Review of Cardiac Radioablation (CR) for Arrhythmias: Procedures, Technology, and Future Opportunities

“…Recent reviews comprehensively detail patient selection, clinical history, treatment outcomes, and treatment toxicities but only briefly mention specific technical aspects of CR. [14][15][16][17][18] This review addresses this knowledge gap by collating currently available knowledge regarding CR technology choice and procedural details to help inform and guide clinics considering implementing their own CR program, to aid technique standardization, and to highlight areas that require further development or verification.…”