4.7 Article

Stereotactic management of arrhythmia- radiosurgery in treatment of ventricular tachycardia (SMART-VT). Results of a prospective safety trial

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RADIOTHERAPY AND ONCOLOGY
卷 188, 期 -, 页码 -

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ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2023.109857

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Arrhythmia; Ventricular tachycardia; Stereotactic body radiotherapy; Radiosurgery; Safety

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This study evaluated the safety and efficacy of stereo-tactic arrhythmia radioablation (STAR) in patients with ventricular tachycardia (VT). The results showed that STAR is a safe and effective treatment, reducing VT burden. However, long-term outcomes still need to be evaluated.
Background and purpose: Despite its increasing popularity, there are limited prospective data on stereo-tactic arrhythmia radioablation (STAR). In this trial, we assessed the safety and efficacy of STAR in patients with ventricular tachycardia (VT), focusing on early treatment-related grade >= 3 adverse events (AE).Materials and methods: This prospective trial was designed for adults with VT recurrence following cathe-ter ablation (CA) despite adequate pharmacotherapy, or contraindications to CA. A single dose of 25 Gy was delivered to the arrhythmia substrate defined on electro-anatomic mapping and cardiac-gated CT. The primary endpoint was safety, defined as two or fewer treatment-related grade >= 3 AEs during the first three months in 11 patients. Additional endpoints included treatment efficacy, clinical and biological markers of cardiac injury, and quality of life.Results: Eleven patients with a median age of 67 years, structural heart disease, and a clinically significant recurrence of VT despite adequate pharmacotherapy and 1-4 previous CAs were enrolled between 2020/09 and 2022/10. Following the treatment, one patient developed a possibly treatment-related grade >= 3 AE, a grade 4 heart failure exacerbation at 87 days, which resolved after conservative treat-ment. There was a total 84.3% reduction in VT burden in 10 evaluable patients; however, VT recurrence was eventually observed in eight, and three patients required additional CAs. Three deaths due to unre-lated causes were recorded.Conclusions: STAR appears to be safe and efficient. It is a promising treatment for selected patients; how-ever, long-term outcomes remain to be evaluated, and controlled trials comparing STAR with standards of care are missing.(c) 2023 The Author(s). Published by Elsevier B.V. Radiotherapy and Oncology 188 (2023) 109857

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