Stereotactic arrhythmia radioablation for refractory ventricular tachycardia-The initial Australian experience

Das, SK; Ryan, T; Panettieri, V; Hawson, J; Lim, T; Hardcastle, N; Chang, D; Goodall, SK; Anderson, RD; Kalman, J; Siva, S; King, BJ; Lee, G

Author(s): Das, SK; Ryan, T; Panettieri, V; Hawson, J; Lim, T; Hardcastle, N; Chang, D; Goodall, SK; Anderson, RD; Kalman, J; Siva, S; King, BJ; Lee, G;
Details: Publication Year 2025-08,Volume 22,Issue #8,Page e364-e373
Journal Title: Heart Rhythm
Publication Type: Research article
Abstract: BACKGROUND: Stereotactic arrhythmia radioablation (STAR) is a novel, noninvasive technique for the management of refractory ventricular tachycardia (VT). OBJECTIVE: This retrospective study aimed to assess the feasibility, efficacy, and safety of STAR in an Australian cohort. METHODS: From February 2020 to August 2023, 12 patients with drug-refractory VT for whom catheter ablation had failed or who were unsuitable for it were treated with STAR in 2 Australian centers. A combination of electrocardiograms, multimodality imaging, and noninvasive or invasive mapping data was used to target the presumed VT substrate. All treatments (25 Gy in 1 fraction) were delivered without anesthesia. Efficacy end points were defined as the number of VT episodes, antitachycardia pacing sequences, VT storms, and shocks 6 months before and after treatment (6-week blanking period). Mortality and adverse event data were collected during 12-month follow-up. RESULTS: In the 9 patients who survived the blanking period, a significant reduction (64.5%; P = .011) in VT burden and VT storm (71.7%; P = .027) was observed during a 6-month follow-up. However, 66.7% (6/9) of these patients experienced VT recurrence; 3 of 6 patients with recurrence with electrocardiograms available for review had the same VT morphology as before STAR. During a 12-month follow-up, 5 patients died and 3 adverse events were recorded (undersensing of defibrillator lead, increased rate of reflux, and radiation pneumonitis). CONCLUSION: This paper summarizes the initial Australian experience treating refractory VT with STAR. It demonstrates that STAR can significantly decrease the VT and VT storm burden during a 6-month follow-up with an acceptable acute adverse effect profile, albeit with a high VT recurrence rate.
Publisher: Elsevier
Keywords: Humans; *Tachycardia, Ventricular/physiopathology/surgery; Male; Female; Australia/epidemiology; Retrospective Studies; Middle Aged; Electrocardiography; *Radiosurgery/methods; Treatment Outcome; *Catheter Ablation/methods; Follow-Up Studies; Aged; Ablation; Stereotactic ablative radiotherapy; Stereotactic arrhythmia radioablation; Sudden cardiac death; Ventricular tachycardia
Department(s): Radiation Oncology; Physical Sciences; Radiation Oncology
Publisher's Version: https://doi.org/10.1016/j.hrthm.2025.02.005
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-02-11 06:48:50

Last Modified: 2025-08-19 07:57:01