Stereotactic arrhythmia radioablation (STAR)-A systematic review and meta-analysis of prospective trials on behalf of the STOPSTORM.eu consortium.

Autor: Miszczyk M; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Collegium Medicum - Faculty of Medicine, WSB University, Dąbrowa Górnicza, Poland. Electronic address: marcinmmiszczyk@gmail.com., Hoeksema WF; Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands., Kuna K; Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland., Blamek S; Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland., Cuculich PS; Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA., Grehn M; Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany., Molon G; Department of Cardiology, IRCCS S.Cuore Don Calabria, Negrar VR, Italy., Nowicka Z; Department of Biostatistics and Translational Medicine, Medical University of Łódź, Łódź, Poland., van der Ree MH; Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands., Robinson CG; Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA., Sajdok M; Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland; Department of Electrocardiology, Upper Silesian Medical Center of the Medical University of Silesia, Katowice, Poland; Doctoral School of the Medical University of Silesia, Katowice, Poland., Verhoeff JJC; Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands., Postema PG; Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam UMC Location University of Amsterdam, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, The Netherlands., Blanck O; Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.
Jazyk: angličtina
Zdroj: Heart rhythm [Heart Rhythm] 2025 Jan; Vol. 22 (1), pp. 80-89. Date of Electronic Publication: 2024 Jul 18.
DOI: 10.1016/j.hrthm.2024.07.029
Abstrakt: Stereotactic arrhythmia radioablation (STAR) is a noninvasive treatment of refractory ventricular tachycardia (VT). In this study, we aimed to systematically review prospective trials on STAR and pool harmonized outcome measures in a meta-analysis. After registration in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023439666), we searched OVID Medline, OVID Embase, Web of Science Core Collection, the Cochrane Central Register of Controlled Trials, and Google Scholar on November 9, 2023, to identify reports describing results of prospective trials evaluating STAR for VT. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions tool. Meta-analysis was performed using generalized linear mixed models. We identified 10 prospective trials in which 82 patients were treated with STAR between 2016 and 2022. The 90-day rate of treatment-related grade ≥3 adverse events was 0.10 (95% confidence interval [CI] 0.04-0.2). The proportions of patients achieving given VT burden reductions were 0.61 (95% CI 0.45-0.74) for ≥95%, 0.80 (95% CI 0.62-0.91) for ≥75%, and 0.9 (95% CI 0.77-0.96) for ≥50% in 63 evaluable patients. The 1-year overall survival rate was 0.73 (95% CI 0.61-0.83) in 81 patients, 1-year freedom from recurrence was 0.30 (95% CI 0.16-0.49) in 61 patients, and 1-year recurrence-free survival was 0.21 in 60 patients (95% CI 0.08-0.46). Limitations include methodological heterogeneity across studies and moderate to significant risk of bias. In conclusion, STAR is a promising treatment method, characterized by moderate toxicity. We observed 1-year mortality of ≈27% in this population of critically ill patients suffering from refractory VT. Most patients experience a significant reduction in VT burden; however, 1-year recurrence rates are high. STAR should still be considered an investigational approach and recommended to patients primarily within the context of prospective trials.
Competing Interests: Disclosures The authors have no disclosures except for the funding sources listed above.
(Copyright © 2024 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE