Stereotactic body radioablation therapy as an immediate and early term antiarrhythmic palliative therapeutic choice in patients with refractory ventricular tachycardia.
ICD therapy
Stereotactic body radioablation therapy
Ventricular tachycardia
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
14
07
2022
accepted:
16
08
2022
pubmed:
31
8
2022
medline:
18
2
2023
entrez:
30
8
2022
Statut:
ppublish
Résumé
Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients' procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT's efficacy as well as the value of using a blanking period following a SBRT session. Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area. During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes. Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.
Sections du résumé
BACKGROUND
BACKGROUND
Stereotactic body radioablation therapy (SBRT) has recently been introduced with the ability to provide ablative energy noninvasively to arrhythmogenic substrate while reducing damage to normal cardiac tissue nearby and minimizing patients' procedural risk. There is still debate regarding whether SBRT has a predominant effect in the early or late period after the procedure. We sought to assess the time course of SBRT's efficacy as well as the value of using a blanking period following a SBRT session.
METHODS
METHODS
Eight patients (mean age 58 ± 14 years) underwent eight SBRT sessions for refractory ventricular tachycardia (VT). SBRT was given using a linear accelerator device with a total dose of 25 Gy to the targeted area.
RESULTS
RESULTS
During a median follow-up of 8 months, all patients demonstrated VT recurrences; however, implantable cardioverter-defibrillator (ICD) and anti-tachycardia pacing therapies were significantly reduced with SBRT (8.46 to 0.83/per month, p = 0.047; 18.50 to 3.29/per month, p = 0.036, respectively). While analyzing the temporal SBRT outcomes, the 2 weeks to 3 months period demonstrated the most favorable outcomes. After 6 months, one patient was ICD therapy-free and the remaining patients demonstrated VT episodes.
CONCLUSIONS
CONCLUSIONS
Our findings showed that the SBRT was associated with a marked reduction in the burden of VT and ICD interventions especially during first 3 months. Although SBRT does not seem to succeed complete termination of VT in long-term period, our findings support the strategy that SBRT can be utilized for immediate antiarrhythmic palliation in critically ill patients with otherwise untreatable refractory VT and electrical storm.
Identifiants
pubmed: 36040658
doi: 10.1007/s10840-022-01352-4
pii: 10.1007/s10840-022-01352-4
pmc: PMC9424800
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
135-143Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Chiu MH, Mitchell LB, Ploquin N, Faruqi S, Kuriachan VP. Review of stereotactic arrhythmia radioablation therapy for cardiac tachydysrhythmias. CJC Open. 2021;3(3):236–47.
doi: 10.1016/j.cjco.2020.11.006
pubmed: 33778440
Gianni C, Rivera D, Burkhardt JD, Pollard B, Gardner E, Maguire P, et al. Stereotactic arrhythmia radioablation for refractory scar-related ventricular tachycardia. Heart Rhythm. 2020;17(8):1241–8.
doi: 10.1016/j.hrthm.2020.02.036
pubmed: 32151737
van der Ree MH, Blanck O, Limpens J, Lee CH, Balgobind BV, Dieleman EMT, et al. Cardiac radioablation-a systematic review. Heart Rhythm. 2020;17(8):1381–92.
doi: 10.1016/j.hrthm.2020.03.013
pubmed: 32205299
Loo BW Jr, Soltys SG, Wang L, Lo A, Fahimian BP, Iagaru A, et al. Stereotactic ablative radiotherapy for the treatment of refractory cardiac ventricular arrhythmia. Circ Arrhythm Electrophysiol. 2015;8(3):748–50.
doi: 10.1161/CIRCEP.115.002765
pubmed: 26082532
Knutson NC, Samson PP, Hugo GD, Goddu SM, Reynoso FJ, Kavanaugh JA, et al. Radiation therapy workflow and dosimetric analysis from a phase 1/2 trial of noninvasive cardiac radioablation for ventricular tachycardia. Int J Radiat Oncol Biol Phys. 2019;104(5):1114–23.
doi: 10.1016/j.ijrobp.2019.04.005
pubmed: 31002942
Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, et al. Technological quality requirements for stereotactic radiotherapy: expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol. 2020;196(5):421–43.
doi: 10.1007/s00066-020-01583-2
pubmed: 32211939
pmcid: 7182540
Lloyd MS, Wight J, Schneider F, Hoskins M, Attia T, Escott C, et al. Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients. Heart Rhythm. 2020;17(3):415–22.
doi: 10.1016/j.hrthm.2019.09.028
pubmed: 31585181
Robinson CG, Samson PP, Moore KMS, Hugo GD, Knutson N, Mutic S, et al. Phase I/II trial of electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia. Circulation. 2019;139(3):313–21.
doi: 10.1161/CIRCULATIONAHA.118.038261
pubmed: 30586734
pmcid: 6331281
Kautzner J, Jedlickova K, Sramko M, Peichl P, Cvek J, Ing LK, et al. Radiation-induced changes in ventricular myocardium after stereotactic body radiotherapy for recurrent ventricular tachycardia. JACC Clin Electrophysiol. 2021;7(12):1487–92.
doi: 10.1016/j.jacep.2021.07.012
pubmed: 34600851
Neuwirth R, Cvek J, Knybel L, Jiravsky O, Molenda L, Kodaj M, et al. Stereotactic radiosurgery for ablation of ventricular tachycardia. Europace. 2019;21(7):1088–95.
doi: 10.1093/europace/euz133
pubmed: 31121018
Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, et al. Noninvasive cardiac radiation for ablation of ventricular tachycardia. N Engl J Med. 2017;377(24):2325–36.
doi: 10.1056/NEJMoa1613773
pubmed: 29236642
pmcid: 5764179
Hohmann S, Henkenberens C, Zormpas C, Christiansen H, Bauersachs J, Duncker D, et al. A novel open-source software-based high-precision workflow for target definition in cardiac radioablation. J Cardiovasc Electrophysiol. 2020;31(10):2689–95.
doi: 10.1111/jce.14660
pubmed: 32648343
Lydiard PS, Blanck O, Hugo G, O’Brien R, Keall P. A review of cardiac radioablation (CR) for arrhythmias: procedures, technology, and future opportunities. Int J Radiat Oncol Biol Phys. 2021;109(3):783–800.
doi: 10.1016/j.ijrobp.2020.10.036
Fahmy TS, Wazni OM, Jaber WA, Walimbe V, Di Biase L, Elayi CS, et al. Integration of positron emission tomography/computed tomography with electroanatomical mapping: a novel approach for ablation of scar-related ventricular tachycardia. Heart Rhythm. 2008;5(11):1538–45.
doi: 10.1016/j.hrthm.2008.08.020
pubmed: 18984529
Poon J, Kohli K, Deyell MW, Schellenberg D, Reinsberg S, Teke T, et al. Technical note: cardiac synchronized volumetric modulated arc therapy for stereotactic arrhythmia radioablation - Proof of principle. Med Phys. 2020;47(8):3567–72.
doi: 10.1002/mp.14237
pubmed: 32415856
Graeff C, Bert C. Noninvasive cardiac arrhythmia ablation with particle beams. Med Phys. 2018;45(11):e1024–35.
doi: 10.1002/mp.12595
pubmed: 30421810
Ouyang Z, Schoenhagen P, Wazni O, Tchou P, Saliba WI, Suh JH, et al. Analysis of cardiac motion without respiratory motion for cardiac stereotactic body radiation therapy. J Appl Clin Med Phys. 2020;21(10):48–55.
doi: 10.1002/acm2.13002
pubmed: 32918386
pmcid: 7592981
Aras D, Ozturk HF, Ozdemir E, Kervan U, Kara M, Cay S, et al. Use of stereotactic radioablation therapy as a bailout therapy for refractory ventricular tachycardia in a patient with a no-entry left ventricle. J Innov Card Rhythm Manag. 2021;12(9):4671–5.
doi: 10.19102/icrm.2021.120902
pubmed: 34595050
pmcid: 8476093
Krüse JJ, Zurcher C, Strootman EG, Bart CI, Schlagwein N, Leer JW, et al. Structural changes in the auricles of the rat heart after local ionizing irradiation. Radiother Oncol. 2001;58(3):303–11.
doi: 10.1016/S0167-8140(00)00327-3
pubmed: 11230892
de Bakker JM, van Capelle FJ, Janse MJ, van Hemel NM, Hauer RN, Defauw JJ, et al. Macroreentry in the infarcted human heart: the mechanism of ventricular tachycardias with a “focal” activation pattern. J Am Coll Cardiol. 1991;18(4):1005–14.
doi: 10.1016/0735-1097(91)90760-7
pubmed: 1894846
Talman V, Ruskoaho H. Cardiac fibrosis in myocardial infarction-from repair and remodeling to regeneration. Cell Tissue Res. 2016;365(3):563–81.
doi: 10.1007/s00441-016-2431-9
pubmed: 27324127
pmcid: 5010608
Zhang DM, Navara R, Yin T, Szymanski J, Goldsztejn U, Kenkel C, et al. Cardiac radiotherapy induces electrical conduction reprogramming in the absence of transmural fibrosis. Nat Commun. 2021;12(1):5558.
doi: 10.1038/s41467-021-25730-0
pubmed: 34561429
pmcid: 8463558
Lehmann HI, Graeff C, Simoniello P, Constantinescu A, Takami M, Lugenbiel P, et al. Feasibility study on cardiac arrhythmia ablation using high-energy heavy ion beams. Sci Rep. 2016;6(1):1–13.
doi: 10.1038/srep38895
Amino M, Yoshioka K, Tanabe T, Tanaka E, Mori H, Furusawa Y, et al. Heavy ion radiation up-regulates Cx43 and ameliorates arrhythmogenic substrates in hearts after myocardial infarction. Cardiovasc Res. 2006;72(3):412–21.
doi: 10.1016/j.cardiores.2006.09.010
pubmed: 17054928
Amino M, Yoshioka K, Fujibayashi D, Hashida T, Furusawa Y, Zareba W, et al. Year-long upregulation of connexin43 in rabbit hearts by heavy ion irradiation. Am J Physiol Heart Circ Physiol. 2010;298(3):H1014–21.
doi: 10.1152/ajpheart.00160.2009
pubmed: 20061548
Amino M, Yoshioka K, Furusawa Y, Tanaka S, Kawabe N, Hashida T, et al. Inducibility of ventricular arrhythmia 1 year following treatment with heavy ion irradiation in dogs with myocardial infarction. Pacing Clin Electrophysiol. 2017;40(4):379–90.
doi: 10.1111/pace.13031
pubmed: 28158934
Benali K, Rigal L, Simon A, Bellec J, Jaïs P, Kamakura T, et al. Correlation between the radiation dose and myocardial remodeling after stereotactic radiation therapy for ventricular tachycardia: first assessment of the dose-effect relationship in humans. Heart Rhythm. 2022;S1547–5271(22):01941–5.
Kiani S, Kutob L, Schneider F, Higgins KA, Lloyd MS. Histopathologic and ultrastructural findings in human myocardium after stereotactic body radiation therapy for recalcitrant ventricular tachycardia. Circ Arrhythm Electrophysiol. 2020;13(11): e008753.
doi: 10.1161/CIRCEP.120.008753
pubmed: 33031001