Stereotactic management of arrhythmia - radiosurgery in treatment of ventricular tachycardia (SMART-VT). Results of a prospective safety trial.

Autor:	Miszczyk M; III(rd) Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland. Electronic address: marcin.miszczyk@gliwice.nio.gov.pl., Sajdok M; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland., Bednarek J; Department of Electrocardiology and Heart Failure, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Ziołowa 45/47 40-635, Katowice, Poland; Department of Cardiology and Structural Heart Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47 40-635, Katowice, Poland; Department of Electrocardiology, John Paul II Hospital, Prądnicka 80 31-202, Kraków, Poland., Latusek T; Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Wojakowski W; Department of Cardiology and Structural Heart Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47 40-635, Katowice, Poland., Tomasik B; Department of Oncology and Radiotherapy, Faculty of Medicine, Medical University of Gdańsk, Mariana Smoluchowskiego 17 80-214, Gdańsk, Poland., Wita K; I(st) Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Ziołowa 47 40-635, Katowice, Poland., Jadczyk T; Department of Cardiology and Structural Heart Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47 40-635, Katowice, Poland; Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital, Pekařská 53 602 00, Brno, Czechia., Kurzelowski R; Department of Cardiology and Structural Heart Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Ziołowa 45/47 40-635, Katowice, Poland., Drzewiecka A; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland., Cybulska M; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland; Department of Electrocardiology and Heart Failure, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Ziołowa 45/47 40-635, Katowice, Poland; CT and MRI Department, Voxel S.A, Radiowa 2 44-100, Gliwice, Poland., Gardas R; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland; Department of Electrocardiology and Heart Failure, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Ziołowa 45/47 40-635, Katowice, Poland., Jarosiński G; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland., Dolla Ł; Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Grządziel A; Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Zub K; Department of Electrocardiology, Upper-Silesian Heart Center, 7th Medical University of Silesia Hospital, Ziołowa 45/47 40-635, Katowice, Poland., Bekman A; Department of Medical Physics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Kaminiów K; III(rd) Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Kozub A; III(rd) Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland., Gołba KS; III(rd) Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland; Department of Electrocardiology and Heart Failure, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Ziołowa 45/47 40-635, Katowice, Poland., Blamek S; Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice branch, Wybrzeże Armii Krajowej 15 44-102, Gliwice, Poland.
Jazyk:	angličtina
Zdroj:	Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2023 Nov; Vol. 188, pp. 109857. Date of Electronic Publication: 2023 Aug 18.
DOI:	10.1016/j.radonc.2023.109857
Abstrakt:	Background and Purpose: Despite its increasing popularity, there are limited prospective data on stereotactic arrhythmia radioablation (STAR). In this trial, we assessed the safety and efficacy of STAR in patients with ventricular tachycardia (VT), focusing on early treatment-related grade ≥ 3 adverse events (AE). Materials and Methods: This prospective trial was designed for adults with VT recurrence following catheter ablation (CA) despite adequate pharmacotherapy, or contraindications to CA. A single dose of 25 Gy was delivered to the arrhythmia substrate defined on electro-anatomic mapping and cardiac-gated CT. The primary endpoint was safety, defined as two or fewer treatment-related grade ≥ 3 AEs during the first three months in 11 patients. Additional endpoints included treatment efficacy, clinical and biological markers of cardiac injury, and quality of life. Results: Eleven patients with a median age of 67 years, structural heart disease, and a clinically significant recurrence of VT despite adequate pharmacotherapy and 1-4 previous CAs were enrolled between 2020/09 and 2022/10. Following the treatment, one patient developed a possibly treatment-related grade ≥ 3 AE, a grade 4 heart failure exacerbation at 87 days, which resolved after conservative treatment. There was a total 84.3% reduction in VT burden in 10 evaluable patients; however, VT recurrence was eventually observed in eight, and three patients required additional CAs. Three deaths due to unrelated causes were recorded. Conclusions: STAR appears to be safe and efficient. It is a promising treatment for selected patients; however, long-term outcomes remain to be evaluated, and controlled trials comparing STAR with standards of care are missing. Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)
Databáze:	MEDLINE
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