TY - JOUR
T1 - Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume
T2 - analysis of the Swiss cohort
AU - Herrera Siklody, Claudia
AU - Schiappacasse, Luis
AU - Jumeau, Raphaël
AU - Reichlin, Tobias
AU - Saguner, Ardan M
AU - Andratschke, Nicolaus
AU - Elicin, Olgun
AU - Schreiner, Frederic
AU - Kovacs, Boldizsar
AU - Mayinger, Michael
AU - Huber, Adrian
AU - Verhoeff, Joost J C
AU - Pascale, Patrizio
AU - Solana Muñoz, Jorge
AU - Luca, Adrian
AU - Domenichini, Giulia
AU - Moeckli, Raphael
AU - Bourhis, Jean
AU - Ozsahin, Esat M
AU - Pruvot, Etienne
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/10/5
Y1 - 2023/10/5
N2 - Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a and results history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
AB - Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a and results history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
KW - Ventricular tachycardia
KW - arrhythmogenic substrate
KW - electrical storm
KW - radiofrequency catheter ablation
KW - stereotactic arrhythmia radioablation
KW - toxicity
UR - http://www.scopus.com/inward/record.url?scp=85179706329&partnerID=8YFLogxK
U2 - 10.1093/europace/euad268
DO - 10.1093/europace/euad268
M3 - Article
C2 - 37695314
SN - 1099-5129
VL - 25
JO - 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
JF - 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
IS - 10
M1 - euad268
ER -