Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices.

Autor: Benali K; Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France.; Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France.; LTSI-UMR 1099, Rennes, France., Lloyd MS; Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA., Petrosyan A; Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France., Rigal L; Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France., Quivrin M; Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France., Bessieres I; Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France., Vlachos K; LTSI-UMR 1099, Rennes, France., Hammache N; Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France., Bellec J; Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France., Simon A; Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France., Laurent G; Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France., Higgins K; Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA., Garnier F; Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France., de Crevoisier R; Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France., Martins R; Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France.; Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France., Da Costa A; Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France., Guenancia C; Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France.; PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2024 Jan; Vol. 35 (1), pp. 206-213. Date of Electronic Publication: 2023 Nov 29.
DOI: 10.1111/jce.16139
Abstrakt: Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
(© 2023 Wiley Periodicals LLC.)
Databáze: MEDLINE
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