Clinical experience of stereotactic body radiation for refractory ventricular tachycardia in advanced heart failure patients.

Stereotactic body radiation therapy (SBRT) has been shown to be effective in treating patients with refractory ventricular tachycardia. The purpose of this study was to describe outcomes for SBRT in advanced heart failure patients admitted for repeated implantable cardioverter-defibrillator (ICD) therapies who were refractory to standard treatments. SBRT simulation, planning, and treatments were performed using standard techniques with collaboration from a radiation oncologist, electrophysiologist, and cardiac imaging specialist. Patients were treated with single-fraction 25 Gy while awake. Efficacy was assessed by total durations in seconds of ventricular tachycardia, frequency of antitachycardia pacing (ATP), and quantity of shocks before and after treatment as recorded by an ICD. A total of 10 patients (mean age 61 years; 3 female) were included. Etiologies of heart failure were ischemic in 40% (4/10) and nonischemic in 60% (6/10). Among 8 patients with available ICD data, the total reduction in seconds of detected VT was 69% (pretreatment 1065 seconds/month vs posttreatment 332 seconds/month). The total reduction in ATP sequences was 48% (17.3 pretreatment and 8.9 posttreatment). Reduction in total ICD shocks after SBRT was 68% (2.9 shocks/month pretreatment and 0.9 shocks/month posttreatment). When excluding a single nonresponder, there was a significant reduction in VT seconds (94%; P = .04) and a trend toward ICD shock reduction (90%; P = .07) post-SBRT. Noninvasive treatment with SBRT was feasible and modestly effective at reducing VT burden in the critically ill. This suggests that SBRT treatment may be a useful palliation for electrical storm.

Lloyd MS ，Wight J ，Schneider F ，Hoskins M ，Attia T ，Escott C ，Lerakis S ，Higgins KA ... -  《-》

Long Term Follow-Up of Stereotactic Body Radiation Therapy for Refractory Ventricular Tachycardia in Advanced Heart Failure Patients.

Initial studies of stereotactic body radiation therapy (SBRT) for refractory ventricular tachycardia (VT) have demonstrated impressive efficacy. Follow-up analyses have found mixed results and the role of SBRT for refractory VT remains unclear. We performed palliative, cardiac radio ablation in patients with ventricular tachycardia refractory to ablation and medical management. Arrhythmogenic regions were targeted by combining computed tomography imaging with electrophysiologic mapping with collaboration from a radiation oncologist, electrophysiologist and cardiac imaging specialist. Patients were treated with a single fraction 25 Gy. Total durations of VT, the quantity of antitachycardia pacing (ATP) and shocks before and after treatment as recorded by implantable cardioverter-defibrillators (ICDs) were analyzed. Follow-up extended until most recent device interrogation unless transplant, death or repeat ablation occurred sooner. Fourteen patients (age 50-78, four females) were treated and had an average of two prior ablations. Nine had ACC/AHA Stage D heart failure and three had left ventricular assist devices (LVAD). Two patients died shortly after SBRT, one received a prompt heart transplant and another had significant VT durations in the following months that were inaccurately recorded by their device. Ten of the 14 patients remained with adequate data post SBRT for analysis with an average follow-up duration of 216 days. Seven of those 10 patients had a decrease in VT post SBRT. Comparing the 90 days before treatment to cumulative follow-up, patients had a 59% reduction in VT, 39% reduction in ATP and a 60% reduction in shocks. Four patients received repeat ablation following SBRT. Pneumonitis was the only complication, occurring in four of the fourteen patients. SBRT may have value in advanced heart failure patients with refractory VT acutely but the utility over long-term follow-up appears modest. Prospective randomized data is needed to better clarify the role of SBRT in managing refractory VT.

Wight J ，Bigham T ，Schwartz A ，Zahid AT ，Bhatia N ，Kiani S ，Shah A ，Westerman S ，Higgins K ，Lloyd MS ... -  《-》

Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia.

Cuculich PS ，Schill MR ，Kashani R ，Mutic S ，Lang A ，Cooper D ，Faddis M ，Gleva M ，Noheria A ，Smith TW ，Hallahan D ，Rudy Y ，Robinson CG ... -  《-》

One-year outcomes after stereotactic body radiotherapy for refractory ventricular tachycardia.

Arkles J ，Markman T ，Trevillian R ，Yegya-Raman N ，Garg L ，Nazarian S ，Santangeli P ，Garcia F ，Callans D ，Frankel DS ，Supple G ，Lin D ，Riley M ，Kumaraeswaran R ，Marchlinski F ，Schaller R ，Desjardins B ，Chen H ，Apinorasethkul O ，Alonso-Basanta M ，Diffenderfer E ，Kim MM ，Feigenberg S ，Zou W ，Marcel J ，Cengel KA ... -  《-》

Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm.

Ninni S ，Gallot-Lavallée T ，Klein C ，Longère B ，Brigadeau F ，Potelle C ，Crop F ，Rault E ，Decoene C ，Lacornerie T ，Lals S ，Kouakam C ，Pontana F ，Lacroix D ，Klug D ，Mirabel X ... -  《-》