Stereotactic radiosurgery for ablation of ventricular
tachycardia

J 2019

Stereotactic radiosurgery for ablation of ventricular tachycardia

NEUWIRTH, Radek, Jakub CVEK, Lukas KNYBEL, Otakar JIRAVSKÝ, Lukas MOLENDA et. al.

Basic information

Original name

Stereotactic radiosurgery for ablation of ventricular tachycardia

Authors

NEUWIRTH, Radek (203 Czech Republic, belonging to the institution), Jakub CVEK (203 Czech Republic, guarantor), Lukas KNYBEL (203 Czech Republic), Otakar JIRAVSKÝ (203 Czech Republic), Lukas MOLENDA (203 Czech Republic), Michal KODAJ (203 Czech Republic), Martin FIALA (203 Czech Republic, belonging to the institution), Petr PEICHL (203 Czech Republic), David FELTL (203 Czech Republic), Jaroslav JANUSKA (203 Czech Republic), Jan HECKO (203 Czech Republic) and Josef KAUTZNER (203 Czech Republic)

Edition

EP Europace, Oxford, Oxford University Press, 2019, 1099-5129

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.045

RIV identification code

RIV/00216224:14110/19:00112603

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1093/europace/euz133

UT WoS

000493046000018

Keywords in English

Ventricular tachycardia; Stereotactic body radiotherapy; Ablation

Abstract

V originále

Aims Stereotactic body radiotherapy (SBRT) for ventricular tachycardias (VTs) could be an option after failed catheter ablation. In this study, we analysed the long-term efficacy and toxicity of SBRT applied as a bail-out procedure. Methods and results Patients with structural heart disease and unsuccessful catheter ablations for VTs underwent SBRT. The planning target volume (PTV) was accurately delineated using exported 3D electroanatomical maps with the delineated critical part of re-entry circuits. This was defined by detailed electroanatomic mapping and by pacing manoeuvres during the procedure. Using the implantable cardioverter-defibrillator lead as a surrogate contrast marker for respiratory movement compensation, 25 Gy was delivered to the PTV using CyberKnife. We evaluated occurrences of sustained VT, electrical storm, antitachycardia pacing, and shock; time to death; and radiation-induced events. From 2014 until March 2017, 10 patients underwent radiosurgical ablation (mean PTV, 22.15 mL; treatment duration, 68 min). After radiosurgery, four patients experienced nausea and one patient presented gradual progression of mitral regurgitation. During the follow-up (median 28 months), VT burden was reduced by 87.5% compared with baseline (P = 0.012) and three patients suffered non-arrhythmic deaths. After the blanking period, VT recurred in eight of 10 patients. The mean time to first antitachycardia pacing and shock were 6.5 and 21 months, respectively. Conclusion Stereotactic body radiotherapy appears to show long-term safety and effectiveness for VT ablation in structural heart disease inaccessible to catheter ablation. We report one possible radiation-related toxicity and promising overall survival, warranting evaluation in a prospective multicentre clinical trial.

Citovat

NEUWIRTH, Radek, Jakub CVEK, Lukas KNYBEL, Otakar JIRAVSKÝ, Lukas MOLENDA, Michal KODAJ, Martin FIALA, Petr PEICHL, David FELTL, Jaroslav JANUSKA, Jan HECKO and Josef KAUTZNER. Stereotactic radiosurgery for ablation of ventricular tachycardia. EP Europace. Oxford: Oxford University Press, 2019, vol. 21, No 7, p. 1088-1095. ISSN 1099-5129. Available from: https://dx.doi.org/10.1093/europace/euz133.

@article{1606876,
   author = {Neuwirth, Radek and Cvek, Jakub and Knybel, Lukas and Jiravský, Otakar and Molenda, Lukas and Kodaj, Michal and Fiala, Martin and Peichl, Petr and Feltl, David and Januska, Jaroslav and Hecko, Jan and Kautzner, Josef},
   article_location = {Oxford},
   article_number = {7},
   doi = {http://dx.doi.org/10.1093/europace/euz133},
   keywords = {Ventricular tachycardia; Stereotactic body radiotherapy; Ablation},
   language = {eng},
   issn = {1099-5129},
   journal = {EP Europace},
   title = {Stereotactic radiosurgery for ablation of ventricular tachycardia},
   url = {http://dx.doi.org/10.1093/europace/euz133},
   volume = {21},
   year = {2019}
}

TY  - JOUR
ID  - 1606876
AU  - Neuwirth, Radek - Cvek, Jakub - Knybel, Lukas - Jiravský, Otakar - Molenda, Lukas - Kodaj, Michal - Fiala, Martin - Peichl, Petr - Feltl, David - Januska, Jaroslav - Hecko, Jan - Kautzner, Josef
PY  - 2019
TI  - Stereotactic radiosurgery for ablation of ventricular tachycardia
JF  - EP Europace
VL  - 21
IS  - 7
SP  - 1088-1095
EP  - 1088-1095
PB  - Oxford University Press
SN  - 10995129
KW  - Ventricular tachycardia
KW  - Stereotactic body radiotherapy
KW  - Ablation
UR  - http://dx.doi.org/10.1093/europace/euz133
L2  - http://dx.doi.org/10.1093/europace/euz133
N2  - Aims Stereotactic body radiotherapy (SBRT) for ventricular tachycardias (VTs) could be an option after failed catheter ablation. In this study, we analysed the long-term efficacy and toxicity of SBRT applied as a bail-out procedure. Methods and results Patients with structural heart disease and unsuccessful catheter ablations for VTs underwent SBRT. The planning target volume (PTV) was accurately delineated using exported 3D electroanatomical maps with the delineated critical part of re-entry circuits. This was defined by detailed electroanatomic mapping and by pacing manoeuvres during the procedure. Using the implantable cardioverter-defibrillator lead as a surrogate contrast marker for respiratory movement compensation, 25 Gy was delivered to the PTV using CyberKnife. We evaluated occurrences of sustained VT, electrical storm, antitachycardia pacing, and shock; time to death; and radiation-induced events. From 2014 until March 2017, 10 patients underwent radiosurgical ablation (mean PTV, 22.15 mL; treatment duration, 68 min). After radiosurgery, four patients experienced nausea and one patient presented gradual progression of mitral regurgitation. During the follow-up (median 28 months), VT burden was reduced by 87.5% compared with baseline (P = 0.012) and three patients suffered non-arrhythmic deaths. After the blanking period, VT recurred in eight of 10 patients. The mean time to first antitachycardia pacing and shock were 6.5 and 21 months, respectively. Conclusion Stereotactic body radiotherapy appears to show long-term safety and effectiveness for VT ablation in structural heart disease inaccessible to catheter ablation. We report one possible radiation-related toxicity and promising overall survival, warranting evaluation in a prospective multicentre clinical trial.
ER  -

NEUWIRTH, Radek, Jakub CVEK, Lukas KNYBEL, Otakar JIRAVSKÝ, Lukas MOLENDA, Michal KODAJ, Martin FIALA, Petr PEICHL, David FELTL, Jaroslav JANUSKA, Jan HECKO and Josef KAUTZNER. Stereotactic radiosurgery for ablation of ventricular tachycardia. \textit{EP Europace}. Oxford: Oxford University Press, 2019, vol.~21, No~7, p.~1088-1095. ISSN~1099-5129. Available from: https://dx.doi.org/10.1093/europace/euz133.

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