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Qian PC, Quadros K, Aguilar M, et al. Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy. JACC Clin Electrophysiol. 2021;doi: 10.1016/j.jacep.2021.06.016.
Qian, P. C., Quadros, K., Aguilar, M., Wei, C., Boeck, M., Bredfeldt, J., Cochet, H., Blankstein, R., Mak, R., Sauer, W. H., Tedrow, U. B., & Zei, P. C. (2021). Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy. JACC. Clinical electrophysiology, . https://doi.org/10.1016/j.jacep.2021.06.016
Qian, Pierre C, et al. "Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy." JACC. Clinical electrophysiology vol. (2021). doi: https://doi.org/10.1016/j.jacep.2021.06.016
Qian PC, Quadros K, Aguilar M, Wei C, Boeck M, Bredfeldt J, Cochet H, Blankstein R, Mak R, Sauer WH, Tedrow UB, Zei PC. Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy. JACC Clin Electrophysiol. 2021 Jul 27; doi: 10.1016/j.jacep.2021.06.016. Epub 2021 Jul 27. PMID: 34364832.
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JACC Clin Electrophysiol. 2021 Jul 27; doi: 10.1016/j.jacep.2021.06.016. Epub 2021 Jul 27.

Substrate Modification Using Stereotactic Radioablation to Treat Refractory Ventricular Tachycardia in Patients With Ischemic Cardiomyopathy.

JACC. Clinical electrophysiology

Pierre C Qian, Ken Quadros, Martin Aguilar, Chen Wei, Michelle Boeck, Jeremy Bredfeldt, Hubert Cochet, Ron Blankstein, Raymond Mak, William H Sauer, Usha B Tedrow, Paul C Zei

Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
  2. Harvard Medical School, Boston, Massachusetts, USA.
  3. Harvard Medical School, Boston, Massachusetts, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA.
  4. IHU Liryc, Univ. Bordeaux and Inria Sophia Antipolis, France, Université de Bordeaux, Pessac, France; Inria, Sophia Antipolis, France.
  5. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: [email protected].

PMID: 34364832 DOI: 10.1016/j.jacep.2021.06.016

Abstract

OBJECTIVES: This study aimed to determine the feasibility of using radioablation for arrhythmogenic a substrate modification.

BACKGROUND: Stereotactic body radiation therapy (SBRT) is a promising therapy for ventricular tachycardia (VT) refractory to catheter ablation.

METHODS: A total of 6 male patients (median age 72 years) with ischemic cardiomyopathy (left ventricular ejection fraction 20% [interquartile range (IQR): 16%-25%]) and VT refractory to antiarrhythmic medications and catheter ablations underwent SBRT to extensive scar substrate. In addition to electroanatomical mapping, 5 of 6 patients had computed tomography segmentation using MUSIC (Institut Hospitalo-Universitaire l'Institut de Rythmologie et Modélisation Cardiaque, Bordeaux, France). Regions of wall thinning <5 mm, calcification, and intramyocardial fat were targeted for radioablation at 25 Gy.

RESULTS: The median planning target volume was 319 (IQR: 280-330) mL. Device-treated or sustained VT episodes were not significantly reduced by radioablation (median 42 [IQR: 19-269] to 29 [IQR: 0-81]; P = 0.438). However, a reduction in device shocks was observed from 12 (IQR: 3-19) to 0 (IQR: 0-1) (P = 0.046). Over a follow-up period of 231 (IQR: 212-311) days, 3 patients died of end-stage heart failure and 3 of 6 patients had possible adverse events (heart failure exacerbation, pneumonia, and an asymptomatic pericardial effusion).

CONCLUSIONS: Substrate modification using SBRT assisted by computed tomography segmentation is feasible for treatment of VT in patients with ischemic cardiomyopathy. Although a significant reduction in device shocks was observed, suboptimal VT burden reduction and significant mortality rate in this cohort of patients with advanced cardiomyopathy underscore the need to improve mechanistic understanding for antiarrhythmic effects to guide dosing and targeting of scar substrates.

Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Keywords: cardiac imaging; radioablation; stereotactic body radiation therapy; ventricular tachycardia

Conflict of interest statement

Funding Support and Author Disclosures Dr Qian was supported by a Bushell Travelling Fellowship from the Royal Australasian College of Physicians. Dr Cochet has received speaking honoraria from Siemen

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