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Noninvasive Cardiac Radioablation for Ventricular Arrhythmias

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

Abstract

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.

Summary

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.

Keywords

Stereotactic radioablation Cardiac arrhythmias Noninvasive ablation Ventricular tachycardia 

Abbreviations

3D-CRT

3-Dimensional conformal radiation therapy

AF

Atrial fibrillation

CT

Computerized tomography

CTV

Clinical target volume

DCM

Dilated cardiomyopathy

EAM

Electroanatomic mapping

ECGI

Electrocardiographic imaging

EPS

Electrophysiology study

ICD

Implantable cardiac defibrillator

ICM

Ischemic cardiomyopathy

IGRT

Image-guided radiation therapy

IMRT

Intensity-modulated radiotherapy

ITV

Internal target volume

MR

Magnetic resonance

NICM

Non-ischemic dilated cardiomyopathy

PET

Positron emission tomography

SBRT

Stereotactic body radiotherapy

SHD

Structural heart disease

SR

Stereotactic radioablation

STAR

Stereotactic arrhythmia radioablation

TCEA

Transcoronary ethanol ablation

PPM

Permanent pacemaker

PTV

Planning target volume

PVC

Premature ventricular complexes

RF

Radiofrequency

RT

Radiation therapy

VA

Ventricular arrhythmia

VF

Ventricular fibrillation

VT

Ventricular tachycardia

Notes

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).

References

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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