Stereotactic arrhythmia radioablation for refractory scar-related ventricular tachycardia
| Autor: | Douglas Rivera, Carola Gianni, Brad Pollard, Patrick Maguire, Paul C. Zei, Andrea Natale, Amin Al-Ahmad, Edward A. Gardner, J. David Burkhardt |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Population Pilot Projects 030204 cardiovascular system & hematology Radiosurgery Ventricular tachycardia Ventricular Function Left 03 medical and health sciences Cicatrix 0302 clinical medicine Recurrence Cyberknife Physiology (medical) Internal medicine medicine Humans 030212 general & internal medicine Prospective Studies Prospective cohort study education Aged education.field_of_study Ischemic cardiomyopathy Ejection fraction business.industry Middle Aged medicine.disease Radiation therapy Heart failure Cardiology Catheter Ablation Tachycardia Ventricular Feasibility Studies Radiology Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Popis: | BackgroundStereotactic radiosurgery is a form of radiotherapy that is performed in a single session and focuses high-dose ionizing radiation beams from a collimated radiation source to a small, localized area of the body. Recently, stereotactic radiosurgery has been applied to arrhythmias (stereotactic arrhythmia radioablation - STAR), with promising results reported in patients with refractory, scar-related ventricular tachycardia (VT), a cohort with known high morbidity and mortality.ObjectiveHerein, we describe our experience with the use of CyberKnife, a frameless image-guided linear accelerator stereotactic radiosurgery system, in conjunction with CardioPlan, a cardiac specific radiotherapy planning software, to treat patients with scar-related VT, detailing its early and mid-to long-term results.MethodsThis is a pilot, prospective study of patients undergoing STAR for refractory VT. The anatomical target for radioablation was defined based on the clinical VT morphology, electroanatomical mapping, and study-specific pre-procedural imaging with cardiac computed tomography. The target volume delineated with the aid of CardioPlan was treated with a prescription radiation dose of 25 Gy delivered in a single fraction by CyberKnife in an outpatient setting. Ventricular arrhythmias and radiation-related adverse events were monitored at follow-up to determine STAR efficacy and safety.ResultsFive patients (100 % male, 63 ± 12 years old, 80 % ischemic cardiomyopathy, left ventricular ejection fraction 34 ± 15 %) with refractory VT underwent STAR between January and June 2018. Radioablation was delivered in 82 ± 11 minutes without acute complications. During a mean follow-up of 12 ± 2 months, all patients experienced clinically significant mid-to late-term ventricular arrhythmia recurrence; two patients died of complications associated with their advanced heart failure. There were no clinical or imaging evidence of radiation necrosis or other radiation-induced complications in the organs at risk surrounding the scar targeted by radioablation.ConclusionDespite good initial results, STAR did not result in effective ventricular arrhythmia control in the long term in a selected, high-risk population of patients with scar-related VT. The safety profile was confirmed to be favorable, with no radiation-related complications observed during follow-up. Further studies are needed to explain these disappointing results. |
| Databáze: | OpenAIRE |
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