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Войти в исследования JACC. Clinical electrophysiology · 2026
Stereotactic Body Radiation Therapy for VT in Chagas Cardiomyopathy: A Prospective Phase I/II Pilot Study.
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Salvajoli Bernardo, Pisani Cristiano F, Kulchetscki Rodrigo M, Cook Jason, Macruz Ferreira Demarchi Léa Maria, Bertotti Ribeiro Victor Augusto, Salvajoli João Victor, Stevenson William G, Scanavacca Mauricio Ibrahim
Аннотация
BACKGROUND: Stereotactic body radiation therapy (SBRT) is a novel noninvasive therapy for ventricular tachycardia (VT), but its role in Chagas cardiomyopathy remains unexplored.
OBJECTIVES: This study aimed to evaluate the safety and preliminary efficacy of SBRT for refractory VT in patients with chronic Chagas cardiomyopathy.
METHODS: We prospectively enrolled patients with Chagas cardiomyopathy and refractory VT who had failed or were ineligible for catheter ablation. A single 25-Gy fraction of SBRT was delivered to an arrhythmogenic substrate identified by multimodality imaging. The primary outcomes were a reduction in VT burden and treatment-related adverse events.
RESULTS: Eleven patients (age: 64.9 ± 6.7 years; LVEF: 31.6 ± 9.8%) with implantable cardioverter-defibrillators, 9 of whom had prior failed ablations, underwent SBRT. The median internal target volume was 27.3 cm3, and the planning target volume was 91.1 cm3. During a median follow-up of 160 days, VT recurred in 10 patients. The median time to recurrence after a 6-week blanking period was 79 days (IQR: 51.5-167). The patient without recurrence died of noncardiac causes 22 days after SBRT. Comparing the 12 months after SBRT with the 6 months before SBRT, there was a statistically significant reduction in the burden of VT episodes (P = 0.040), antitachycardia pacing therapies (P = 0.012), and combined antitachycardia pacing/shocks (P = 0.022), although isolated implantable cardioverter-defibrillator shocks were not statistically significantly reduced. The 12-month overall survival was 45.5%, and no severe treatment-related adverse events were reported.
CONCLUSIONS: SBRT is a feasible approach for refractory VT in Chagas cardiomyopathy. Despite a high rate of VT recurrence, SBRT statistically significantly reduced the burden of ventricular arrhythmia, warranting further investigation.
OBJECTIVES: This study aimed to evaluate the safety and preliminary efficacy of SBRT for refractory VT in patients with chronic Chagas cardiomyopathy.
METHODS: We prospectively enrolled patients with Chagas cardiomyopathy and refractory VT who had failed or were ineligible for catheter ablation. A single 25-Gy fraction of SBRT was delivered to an arrhythmogenic substrate identified by multimodality imaging. The primary outcomes were a reduction in VT burden and treatment-related adverse events.
RESULTS: Eleven patients (age: 64.9 ± 6.7 years; LVEF: 31.6 ± 9.8%) with implantable cardioverter-defibrillators, 9 of whom had prior failed ablations, underwent SBRT. The median internal target volume was 27.3 cm3, and the planning target volume was 91.1 cm3. During a median follow-up of 160 days, VT recurred in 10 patients. The median time to recurrence after a 6-week blanking period was 79 days (IQR: 51.5-167). The patient without recurrence died of noncardiac causes 22 days after SBRT. Comparing the 12 months after SBRT with the 6 months before SBRT, there was a statistically significant reduction in the burden of VT episodes (P = 0.040), antitachycardia pacing therapies (P = 0.012), and combined antitachycardia pacing/shocks (P = 0.022), although isolated implantable cardioverter-defibrillator shocks were not statistically significantly reduced. The 12-month overall survival was 45.5%, and no severe treatment-related adverse events were reported.
CONCLUSIONS: SBRT is a feasible approach for refractory VT in Chagas cardiomyopathy. Despite a high rate of VT recurrence, SBRT statistically significantly reduced the burden of ventricular arrhythmia, warranting further investigation.