Advantages and challenges for noninvasive atrial fibrillation ablation
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Advantages and challenges for noninvasive atrial fibrillation ablation Masaaki Shoji 1 & Koji Inaba 2 & Jun Itami 2 & Minoru Hamada 3 & Hiroyuki Okamoto 4 & Takeshi Iwasa 1 & Takeshi Ushigusa 5 & Masayuki Yoshida 5 & Taka-aki Matsuyama 6 & Takayuki Otsuka 7 & Koichiro Kumagai 8 & Kenzo Hirao 9 & Patrick Maguire 10 & Pierre Qian 11 & Edward Gardner 12 & Paul C. Zei 11 Received: 25 August 2020 / Accepted: 21 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Although catheter ablation is an effective therapy for atrial fibrillation (AF), risks remain and improved efficacy is desired. Stereotactic radiotherapy is a well-established therapy used to noninvasively treat malignancies with precision. We sought to evaluate stereotactic arrhythmia radioablation (STAR) as a therapeutic option for treating AF. Methods and results Three cancer patients with drug refractory AF were enrolled. Planning software using 3-D CT of the left atrium was used to design a desired ablation volume encompassing antral circumferential pulmonary vein isolation, roof and floor lines to create a “box” lesion set. After planning, patients were treated in the radioablation suite. STAR was able to deliver the intended radiation dose to the target in all 3 patients. No complications were observed over a follow-up period of 24 months. One patient with paroxysmal AF died from deterioration of cancer. The autopsy revealed evidence of fibroblasts and fibrogenesis in the region of atrial tissues targeted with radioablation. In one of these patients, left atrial posterior wall electrograms recorded from the esophagus before and 3 months after STAR indicated successful electrical isolation. Conclusions This is the first report of non-invasive radioablation of the left atrium with demonstration of successful electrical isolation. Although STAR may be safe and effective in delivering ablative energy to the left atrium, further evaluation is warranted regarding effectiveness. Keywords Atrial fibrillation . Ablation . Radioablation . Noninvasive ablation . New technology
Abbreviations AF Atrial fibrillation CT Computed tomography DLBCL Diffuse large B-cell lymphoma ECG Electrocardiogram IRB Institutional review board
LA LSPAF LV NCC PV PVI
* Masaaki Shoji [email protected]
6
Department of Legal Medicine, Showa University School of Medicine, Tokyo, Japan
7
Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
8
Heart Rhythm Center, Fukuoka Sanno Hospital, Fukuoka, Japan
9
Division of Cardiovascular Medicine, AOI Universal Hospital, Kanagawa, Japan
10
MedDevice Pharma LLC, Menlo Park, CA, USA
Department of Medical Physics, National Cancer Center Hospital, Tokyo, Japan
11
Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Boston, MA, USA
Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
12
Cyberheart, Inc., Mountain View, CA, USA
1
Department of Cardiovascular Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045,
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