Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
Stereotactic radioablation for ventricular tachycardia in patients untreatable by catheter ablation: evidence of efficacy, safety, and impact on coronary arteries.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Carbucicchio Corrado, Schiavone Marco, Piperno Gaia, Mancini Maria Elisabetta, Cattani Federica, Sabatino Mariano, Ferrari Annamaria, Bonomi Alice, Marchetti Francesca, Bianchini Lorenzo, Rondi Elena, Ventura Ettore, Mushtaq Saima, Catto Valentina, Orecchia Roberto, Pompilio Giulio, Tondo Claudio, Pontone Gianluca, Jereczek-Fossa Barbara Alicja
Аннотация
AIMS: Ventricular tachycardia (VT) in patients with structural heart disease can be life-threatening and may persist despite anti-arrhythmic therapy and catheter ablation. When standard treatments are ineffective or contraindicated, stereotactic arrhythmia radioablation (STAR) has emerged as a non-invasive salvage option.
METHODS AND RESULTS: This prospective, single-centre study included 19 patients with structural heart disease and recurrent VT unresponsive to conventional therapy and who were ineligible for ablation. Patients were selected by a multidisciplinary team and underwent cardiac CT and electroanatomic mapping for substrate characterization. STAR was delivered in a single 25 Gy fraction using volumetric modulated arc therapy. Primary endpoints included safety (adverse events within 12 months) and efficacy (reduction in VT burden, assessed by ICD-recorded anti-tachycardia pacing [ATP] and shocks). During a median follow-up of 14 months [IQR 9-15], STAR was associated with a significant reduction in ICD therapies, with an average decrease of 81%. Mean ATP interventions/month dropped from 4.5 ± 6.5 to 0.8 ± 2.3 (P = 0.029), and total ICD therapies/month decreased from 4.8 ± 7.0 to 0.9 ± 2.5 (P = 0.032). Mild pulmonary injury and pericardial effusion occurred in 22.2% of patients. Most cases were asymptomatic; one patient (5.5%) required non-urgent pericardiocentesis. No significant changes in left ventricular function, valvular status, or coronary artery disease progression (assessed by CAD-RADS and PCAT analysis) were observed. One-year mortality was 33.3%; no deaths were directly attributable to STAR.
CONCLUSION: STAR shows promise as a safe, non-invasive option for patients with refractory VT and advanced cardiomyopathy. Larger multicentre studies are needed to confirm long-term outcomes and better define its clinical role.
METHODS AND RESULTS: This prospective, single-centre study included 19 patients with structural heart disease and recurrent VT unresponsive to conventional therapy and who were ineligible for ablation. Patients were selected by a multidisciplinary team and underwent cardiac CT and electroanatomic mapping for substrate characterization. STAR was delivered in a single 25 Gy fraction using volumetric modulated arc therapy. Primary endpoints included safety (adverse events within 12 months) and efficacy (reduction in VT burden, assessed by ICD-recorded anti-tachycardia pacing [ATP] and shocks). During a median follow-up of 14 months [IQR 9-15], STAR was associated with a significant reduction in ICD therapies, with an average decrease of 81%. Mean ATP interventions/month dropped from 4.5 ± 6.5 to 0.8 ± 2.3 (P = 0.029), and total ICD therapies/month decreased from 4.8 ± 7.0 to 0.9 ± 2.5 (P = 0.032). Mild pulmonary injury and pericardial effusion occurred in 22.2% of patients. Most cases were asymptomatic; one patient (5.5%) required non-urgent pericardiocentesis. No significant changes in left ventricular function, valvular status, or coronary artery disease progression (assessed by CAD-RADS and PCAT analysis) were observed. One-year mortality was 33.3%; no deaths were directly attributable to STAR.
CONCLUSION: STAR shows promise as a safe, non-invasive option for patients with refractory VT and advanced cardiomyopathy. Larger multicentre studies are needed to confirm long-term outcomes and better define its clinical role.