Noninvasive Cardiac Radioablation for Ventricular Arrhythmias
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ARRHYTHMIAS (J. BUNCH, SECTION EDITOR)
Noninvasive Cardiac Radioablation for Ventricular Arrhythmias Alexander J. Sharp 1 & Raymond Mak 2 & Paul C. Zei 3
# Springer Science+Business Media, LLC, part of Springer Nature 2019
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
This article is part of the Topical Collection on Arrhythmias * Alexander J. Sharp [email protected] 1
Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Hills Rd, Cambridge CB2 0QQ, UK
2
Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Dana-Farber Cancer Institute, 75 Francis St, Boston, MA 02115, USA
3
Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical School, 70 Francis St, Boston, MA 02115, USA
EPS ICD ICM IGRT IMRT ITV MR NICM PET SBRT SHD SR STAR TCEA PPM PTV PVC RF RT VA VF VT
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
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