Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy

Qian, Pierre; Quadros, Ken; Aguilar, Martín; Wei, Chen; Boeck, Michelle; Bredfeldt, Jeremy S.; Cochet, Hubert; Blankstein, Ron; Mak, Raymond H.; Sauer, William H.; Tedrow, Usha B.; Zei, Paul C.

doi:10.1016/j.jacep.2021.06.016

Cited by 32 publications

(28 citation statements)

References 18 publications

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“…In 4 patients, CA and SBRT were performed during the same hospitalization. The median time between admission for ES and SBRT was 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Ninni

Gallot-Lavallée

Klein

et al. 2022

Circ: Arrhythmia and Electrophysiology

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Background: Stereotactic body radiotherapy (SBRT) has been reported as a safe and efficient therapy for treating refractory ventricular tachycardia (VT) despite optimal medical treatment and catheter ablation. However, data on the use of SBRT in patients with electrical storm (ES) is lacking. The aim of this study was to assess the clinical outcomes associated with SBRT in the context of ES. Methods: This retrospective study included patients who underwent SBRT in the context of ES from March 2020 to March 2021 in one tertiary center (CHU Lille). The target volume was delineated according to a predefined workflow. The efficacy was assessed with the following end points: sustained VT recurrence, VT reduced with antitachycardia pacing, and implantable cardioverter defibrillator shock. Results: Seventeen patients underwent SBRT to treat refractory VT in the context of ES (mean 67±12.8 age, 59% presenting ischemic heart disease, mean left ventricular ejection fraction: 33.7± 9.7%). Five patients presented with ES related to incessant VT. Among these 5 patients, the time to effectiveness ranged from 1 to 7 weeks after SBRT. In the 12 remaining patients, VT recurrences occurred in 7 patients during the first 6 weeks following SBRT. After a median 12.5 (10.5–17.8) months follow-up, a significant reduction of the VT burden was observed beyond 6 weeks (−91% [95% CI, 78–103]), P <0.0001). The incidence of implantable cardioverter defibrillator shock and antitachycardia pacing was 36% at 1 year. Conclusions: SBRT is associated with a significant reduction of the VT burden in the event of an ES; however, prospective randomized control trials are needed. In patients without incessant VT, recurrences are observed in half of patients during the first 6 weeks. VT tolerance and implantable cardioverter defibrillator programming adjustments should be integrated as part of an action plan defined before SBRT for each patient.

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“…In 4 patients, CA and SBRT were performed during the same hospitalization. The median time between admission for ES and SBRT was 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) days.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Ninni

Gallot-Lavallée

Klein

et al. 2022

Circ: Arrhythmia and Electrophysiology

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“…In 6 studies, there was a significant reduction (>80%) of VT burden at follow-up. In other studies reduction of VT burden at follow up ranges between 30 and 70% (9,10,16), or there was no reduction in one case (13).…”

Section: Discussionmentioning

confidence: 87%

“…Three retrospective case series (7)(8)(9), two retrospective (10,11), and five prospective studies (12)(13)(14)(15)(16) were included in our systematic review. The baseline characteristics of the patients included in the analysis are reported in Table 1.…”

Section: Resultsmentioning

confidence: 99%

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

Volpato

Compagnucci

Cipolletta

et al. 2022

Front. Cardiovasc. Med.

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Catheter ablation (CA) is a fundamental therapeutic option for the treatment of recurrent ventricular arrhythmias. Notwithstanding the tremendous improvements in the available technology and the increasing amount of evidence in support of CA, in some patients the procedure fails, or is absolutely contraindicated due to technical or clinical issues. In these cases, the clinical management of patients is highly challenging, and mainly involves antiarrhythmic drugs escalation. Over the last 5 years, stereotactic arrhythmia radioablation (STAR) has been introduced into clinical practice, with several small studies reporting favorable arrhythmia-free outcomes, without severe side effects at a short to mid-term follow-up. In the present systematic review, we provide an overview of the available studies on stereotactic arrhythmia radioablation, by describing the potential indications and technical aspects of this promising therapy.

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“…For a more detailed workflow, see Supplemental Figure S1. The full description of the approach has been described previously 5 . In brief, patients were evaluated jointly by a multidisciplinary team.…”

Section: Methodsmentioning

confidence: 99%

Cost of cardiac stereotactic body radioablation therapy versus catheter ablation for treatment of ventricular tachycardia

Wei

Boeck

Qian

et al. 2022

Pacing Clinical Electrophis

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Aims To compare the cost of cardiac stereotactic body radioablation therapy (SBRT) versus catheter ablation for treating ventricular tachycardia (VT). Background Cardiac SBRT is a novel way of treating refractory VT that may be less costly than catheter ablation, owing to its noninvasive, outpatient nature. However, the true costs of either procedure are not well described, which could help inform a more appropriate reimbursement for cardiac SBRT than simply cross‐indexing existing procedural rates. Methods Process maps were derived for the full patient care cycle of both procedures using time‐driven activity‐based costing. Step‐by‐step timestamps were collected prospectively from a 10‐patient SBRT cohort and retrospectively from a 59‐patient catheter ablation cohort. Individual costs were estimated by multiplying timestamps with capacity cost rates (CCRs) for personnel, space, equipment, consumable, and indirect resources. These were summed into total cost, which for cardiac SBRT was compared with current catheter ablation and single‐fraction lung SBRT reimbursements, both potential reference rates for cardiac SBRT. Results The direct and total procedural costs of cardiac SBRT ($7549 and $10,621) were 49% and 54% less than those of VT ablation ($14,707 and $23,225). These costs were significantly different from current reimbursement for catheter ablation ($22,692) and lung SBRT ($6329). After including hospitalization expenses (≥$15,000), VT ablation costs at least $27,604 more to furnish than cardiac SBRT. Conclusions Time‐driven activity‐based costing (TDABC) can be a helpful tool for assessing healthcare costs, including novel treatment approaches. In addition to its clinical benefits, cardiac SBRT may provide significant cost reduction opportunities for treatment of VT.

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Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy

Cited by 32 publications

References 18 publications

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm

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

Cost of cardiac stereotactic body radioablation therapy versus catheter ablation for treatment of ventricular tachycardia

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