Cardiac stereotactic body radiation therapy in advanced heart failure patients with recurrent ventricular tachycardia – a case series

    Authors

    Keywords

    stereotactic body radiotherapy, ventricular tachycardia, advanced heart failure

    DOI

    https://doi.org/10.15836/ccar2024.405

    Full Text

    **Introduction**: Cardiac stereotactic body radiotherapy (SBRT) is a treatment option for patients with refractory ventricular tachycardia (VT) despite optimal medical therapy and one or more failed catheter ablation procedures. (1) Several studies have reported that SBRT is associated with reduced VT burden and implantable cardioverter defibrillator (ICD) therapies. (2) This study aimed to assess the clinical outcomes of cardiac SBRT for VT in our institution. **Patients and Methods**: The target substrate for radioablation was determined by combining a preprocedural cardiac computed tomography (CT) scan and 3D cardiac modeling software merged with a real-time CT scan for simulation. All patients were treated with a single 25 Gy fraction using respiratory motion mitigation strategies. We analyzed the outcome of death, the incidence of recurrent VT, and possible side effects of irradiation. **Results**: Three men aged 34, 61, and 66 years with advanced heart failure as a consequence of ischemic heart disease were referred for cardiac SBRT due to VT and ICD therapy recurrence despite antiarrhythmic drugs (AADs) and previously failed catheter ablations for VT. Cardiac SBRT was successfully performed in all patients. During the follow-up, all patients had VT recurrence. In two patients, it happened during a 6-week blanking period, while the third patient had VT recurrence after six months. Two patients eventually received a heart transplant, one and ten months after cardiac SBRT, respectively. The third patient underwent endocardial-epicardial catheter ablation for VT a month after receiving cardiac SBRT, but eventually died nine months post-SBRT due to advanced heart failure worsening. There were no radiotherapy-related adverse events observed during follow-up. **Conclusion**: We demonstrated the feasibility and safety of cardiac SBRT in advanced heart failure patients. However, cardiac SBRT did not achieve successful mid-term arrhythmia control in our selected high-risk patients, and, therefore, efficacy aspects remain unclear. Further studies are needed to clarify this issue.

    Literature

    1. Ninni S, Gallot-Lavallée T, Klein C, Longère B, Brigadeau F, Potelle C, et al. Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm. Circ Arrhythm Electrophysiol. 2022 September;15(9):e010955. https://doi.org/10.1161/CIRCEP.122.010955
    2. Arkles J, Markman T, Trevillian R, Yegya-Raman N, Garg L, Nazarian S, et al. One-year outcomes after stereotactic body radiotherapy for refractory ventricular tachycardia. Heart Rhythm. 2024 January;21(1):18–24. https://doi.org/10.1016/j.hrthm.2023.10.005
    Cardiologia Croatica
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    Cardiac stereotactic body radiation therapy in advanced heart failure patients with recurrent ventricular tachycardia – a case series

    Extended Abstract
    Issue11-12
    Published
    Pages405
    PDF via DOIhttps://doi.org/10.15836/ccar2024.405
    stereotactic body radiotherapy
    ventricular tachycardia
    advanced heart failure

    Authors

    Vedran Pašara*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivan PrepolecORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Andrija NekićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Hrvoje ŠobatORCIDSpecial Hospital Radiochirurgia Zagreb, Sveta Nedelja, Croatia
    Dragan SchwarzORCIDSpecial Hospital Radiochirurgia Zagreb, Sveta Nedelja, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vedran VelagićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    *Correspondence email: vedran.pasara@gmail.com

    Full Text

    Introduction: Cardiac stereotactic body radiotherapy (SBRT) is a treatment option for patients with refractory ventricular tachycardia (VT) despite optimal medical therapy and one or more failed catheter ablation procedures. (1) Several studies have reported that SBRT is associated with reduced VT burden and implantable cardioverter defibrillator (ICD) therapies. (2) This study aimed to assess the clinical outcomes of cardiac SBRT for VT in our institution.

    Patients and Methods: The target substrate for radioablation was determined by combining a preprocedural cardiac computed tomography (CT) scan and 3D cardiac modeling software merged with a real-time CT scan for simulation. All patients were treated with a single 25 Gy fraction using respiratory motion mitigation strategies. We analyzed the outcome of death, the incidence of recurrent VT, and possible side effects of irradiation.

    Results: Three men aged 34, 61, and 66 years with advanced heart failure as a consequence of ischemic heart disease were referred for cardiac SBRT due to VT and ICD therapy recurrence despite antiarrhythmic drugs (AADs) and previously failed catheter ablations for VT. Cardiac SBRT was successfully performed in all patients. During the follow-up, all patients had VT recurrence. In two patients, it happened during a 6-week blanking period, while the third patient had VT recurrence after six months. Two patients eventually received a heart transplant, one and ten months after cardiac SBRT, respectively. The third patient underwent endocardial-epicardial catheter ablation for VT a month after receiving cardiac SBRT, but eventually died nine months post-SBRT due to advanced heart failure worsening. There were no radiotherapy-related adverse events observed during follow-up.

    Conclusion: We demonstrated the feasibility and safety of cardiac SBRT in advanced heart failure patients. However, cardiac SBRT did not achieve successful mid-term arrhythmia control in our selected high-risk patients, and, therefore, efficacy aspects remain unclear. Further studies are needed to clarify this issue.

    Literature

    1. 1.
      Ninni S, Gallot-Lavallée T, Klein C, Longère B, Brigadeau F, Potelle C, et al. Stereotactic Radioablation for Ventricular Tachycardia in the Setting of Electrical Storm. Circ Arrhythm Electrophysiol. 2022 September;15(9):e010955.DOI
    2. 2.
      Arkles J, Markman T, Trevillian R, Yegya-Raman N, Garg L, Nazarian S, et al. One-year outcomes after stereotactic body radiotherapy for refractory ventricular tachycardia. Heart Rhythm. 2024 January;21(1):18–24.DOI