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

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

Automated summary

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.