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Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience

Journal of Interventional Cardiac Electrophysiology volume 61, pages 535–543 (2021)Cite this article

Abstract

Background

Initial studies have reported excellent safety and efficacy for stereotactic body radiation therapy (SBRT) in patients with refractory ventricular tachycardia (VT).

Methods

This is a single-center retrospective analysis of eight consecutive patients who underwent SBRT for refractory, scar-related VT. The anatomic target for radioablation was defined based on surface 12-lead ECG VT morphology, cardiac magnetic resonance imaging, and electroanatomic mapping data when available. The target volume treated and the prescribed radiation dose (15–25 Gy) was based on the combined clinical assessment of the cardiac electrophysiologist and radiation oncologist. Ventricular arrhythmias, radiation-related outcomes, and adverse events were monitored at follow-up.

Results

Eight patients underwent nine SBRT sessions. All patients were male with an average age of 75 ± 7.3 years and mean ejection fraction of 21 ± 7%. SBRT was performed with delivery of an average of 22.2 ± 3.6 Gy in a single session with a procedure time of 18.2 ± 6.0 min. All but one session was performed on an inpatient basis. No acute complications occurred. During a median follow-up of 7.8 months (IQR 4.8, 9.9), ICD therapies decreased from median 69.5 (43.5, 115.8) pre-SBRT to 13.3 (IQR 7.7, 35.8) post-SBRT (p = 0.036). There were three patient deaths in the follow-up period, unrelated to SBRT. Apparent clinical benefit occurred 33% of the time after SBRT.

Conclusions

The patients experienced overall reduction in VT burden following SBRT, though not with the immediate effect seen in other patient series. Further studies (basic, translational, and clinical) are essential to determine the benefit of SBRT and if so, the optimal protocols and patient selection.

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Funding

This study was supported by OT OT2OD028201 (to KS, MV, OAA, and JB).

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Author notes

  1. Robert Chin and Justin Hayase contributed equally to this work.

Affiliations

  1. Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Robert Chin, Minsong Cao, Jie Deng & Michael Steinberg

  2. UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA, 90095, USA

    Justin Hayase, Olujimi Ajijola, Duc Do, Marmar Vaseghi, Eric Buch, Houman Khakpour, Osamu Fujimura, Yuliya Krokhaleva, Carlos Macias, Julie Sorg, Jean Gima, Geraldine Pavez, Noel G. Boyle, Kalyanam Shivkumar & Jason S. Bradfield

  3. Department of Radiological Services, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Peng Hu

Authors
  1. Robert Chin
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  2. Justin Hayase
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  3. Peng Hu
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  19. Kalyanam Shivkumar
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  20. Jason S. Bradfield
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Corresponding author

Correspondence to Jason S. Bradfield.

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Retrospective data analysis was performed under a protocol approved by the institutional review board.

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The authors declare that they have no conflict of interest.

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Chin, R., Hayase, J., Hu, P. et al. Non-invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience. J Interv Card Electrophysiol 61, 535–543 (2021). https://doi.org/10.1007/s10840-020-00849-0

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  • DOI: https://doi.org/10.1007/s10840-020-00849-0

Keywords

  • Ventricular tachycardia
  • Stereotactic body radiation therapy
  • Ablation
  • Non-invasive