Abstract 9609: Pioneering Cardiac Radioablation With the Use of an MRI Linear Accelerator. Can We Use a Gamma Knife ® to the Heart as We Do in the Brain?
| Autor: | Robert W Biederman, Emerson Liu, Danny Lee, Seungjong Oh, Daniel Pavord, Mark Trombetta, Martin Fast, Tom Colonias, Joost Verhoeff, Mark Doyle, George Shaw, Amit Thosani, David Parda, Jason Sohn |
|---|---|
| Rok vydání: | 2021 |
| Předmět: | |
| Zdroj: | Circulation. 144 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Introduction: VT is often refractory to medical therapy and on rare but critical cases, even EP ablation. Despite investigation into endocardial, mesocardial and occasionally even epicardial ablation for these recalcitrant and deadly arrhythmias, there remains an inability to more effectively, non-invasively, treat VT. Hypothesis: We propose that, paralleling a Gamma Knife ® approach, the use of a novel MRI linear accelerator (MR Linac), the Unity ® (Elekta AB, Stockholm, Sweden), a proof of concept could be applied to highly selected pts with obstinate VT. Methods: A multi-center team with EP, Radiation Oncology and CMR (GE 1.5T) in joint development with Pittsburgh, PA and Utrecht, The Netherlands, developed a completely EP-CMR-guided method for non-invasive VT ablation utilizing S tereo T actic A rrhythmia R adioablation (STAR) with 25 Gy in a single fraction via MR Linac. Results: To evaluate deliverability and applicability of MR Linac plans, four IMRT per clinical scan were developed with varying delivery parameters (7A: 7-beams: 52 o in 70 segments (seg), 7B: 7-beams: 52 o in 100 seg, 15A: 15-beams: 24 o in 70 seg, and 15B: 15-beams: 24 o in 100 seg). We used a 0.2 cm dose grid and a 1% uncertainty via Monte Carlo ® dose calculation. Pt specific QA/QC used ArcCHECK ® (Sun Nuclear, FL) to evaluate individual IMRT plans. 3D CMR with LGE scar fusion for lesion integration guided non-invasive MR LinAc ablation. Accordingly, all IMRT plans were clinically acceptable (>97% of 7-beams and ≥98.0% of 15-beams in 3%/3mm gamma) for MR LinAc VT-ablation successfully with pt target effective arrhythmogenic myocardial ROI volume as ascertained via CMR of 63-99cm 3 . All 4 pts tolerated the 25±5min procedure without esophageal, pericardial or pro-arrhythmic complications and were alive at 30d FU with marked attenuation of VT burden. At 30d FU, no SAE's occurred to include pro-arrhythmias, pericardial effusions or esophageal fistulas. Conclusions: Refractory, complex and anatomically endocardially-remote VT has the potential to be curative, incorporating an analogous Gamma Knife ® approach via MR Linac radioablation heralding a migration to the Unity ® platform. This nearly first-in-man p r oof of concept approach may shepherd a new methodologic era into heretofore intractable VT. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|