Noninvasive Cardiac Radioablation for Ventricular Arrhythmias

  • Alexander J. SharpEmail author
  • Raymond Mak
  • Paul C. Zei
Arrhythmias (J. Bunch, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Arrythmias


Purpose of Review

In this review, we describe the general principles and clinical use of stereotactic radioablation (SR) and its specific application to the treatment of malignant cardiac ventricular arrhythmias, or stereotactic arrhythmia radioablation (STAR). The principles of STAR, and the unmet needs in cardiac arrhythmia ablation are described. The basic pathophysiology of radioablative effect on cardiac tissues, the clinical experience to date, and future directions are discussed.

Recent Findings

Basic preclinical research has demonstrated in large animal models (porcine, canine) that delivery of SR energy to cardiac targets, specifically left atrial ablation for atrial fibrillation, results in physiologic and histopathologic evidence of treatment effect without evidence of harm. Clinical treatments delivering SR to ventricular and atrial targets for ventricular tachycardia (VT) and atrial fibrillation (AF) have demonstrated clinical response without evidence of obvious harm or complication thus far.


In the nascent but exciting field of stereotactic radioablation for treatment of cardiac arrhythmias, preclinical evidence has demonstrated treatment effect without to date risk of significant collateral injury. In limited clinical experience treating both ventricular and atrial arrhythmias, clinical benefit in arrhythmia reduction without notable risk of complication has been observed. Further basic mechanistic research, refinement of delivery approaches, and further clinical experience are all anticipated and needed.


Stereotactic radioablation Cardiac arrhythmias Noninvasive ablation Ventricular tachycardia 



3-Dimensional conformal radiation therapy


Atrial fibrillation


Computerized tomography


Clinical target volume


Dilated cardiomyopathy


Electroanatomic mapping


Electrocardiographic imaging


Electrophysiology study


Implantable cardiac defibrillator


Ischemic cardiomyopathy


Image-guided radiation therapy


Intensity-modulated radiotherapy


Internal target volume


Magnetic resonance


Non-ischemic dilated cardiomyopathy


Positron emission tomography


Stereotactic body radiotherapy


Structural heart disease


Stereotactic radioablation


Stereotactic arrhythmia radioablation


Transcoronary ethanol ablation


Permanent pacemaker


Planning target volume


Premature ventricular complexes




Radiation therapy


Ventricular arrhythmia


Ventricular fibrillation


Ventricular tachycardia


Compliance with Ethical Standards

Conflict of Interest

Dr. Sharp has nothing to disclose.

Dr. Mak reports personal fees from AstraZeneca and personal fees from New RT, outside the submitted work.

Dr. Zei reports grants and personal fees from Cyberheart, Inc., grants and personal fees from Biosense Webster, Inc., and personal fees from Abbott/St Jude Medical, Inc., during the conduct of the study.

Human and Animal Rights

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alexander J. Sharp
    • 1
    Email author
  • Raymond Mak
    • 2
  • Paul C. Zei
    • 3
  1. 1.Addenbrooke’s HospitalCambridge University Hospitals NHS TrustCambridgeUK
  2. 2.Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical SchoolDana-Farber Cancer InstituteBostonUSA
  3. 3.Cardiac Arrhythmia Service, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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