Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience
Justin Lee, Matthew Bates, Ewen Shepherd, Stephen Riley, Michael Henshaw, Peter Metherall, Jim Daniel, A. Blower, David Scoones, Michele Wilkinson, Neil D. Richmond, Clifford G. Robinson, Phillip S. Cuculich, Geoffrey D. Hugo, Neil Seller, R. McStay, Nicholas Child, Andrew Thornley, Nicholas F. Kelland, Philip J. Atherton, C. Peedell, M. Hatton
Abstract
BACKGROUND: Options for patients with ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or catheter ablation remain limited. Stereotactic radiotherapy has been described as a novel treatment option. METHODS: Seven patients with recurrent refractory VT, deemed high risk for either first time or redo invasive catheter ablation, were treated across three UK centres with non-invasive cardiac stereotactic ablative radiotherapy (SABR). Prior catheter ablation data and non-invasive mapping were combined with cross-sectional imaging to generate radiotherapy plans with aim to deliver a single 25 Gy treatment. Shared planning and treatment guidelines and prospective peer review were used. RESULTS: Acute suppression of VT was seen in all seven patients. For five patients with at least 6 months follow-up, overall reduction in VT burden was 85%. No high-grade radiotherapy treatment-related side effects were documented. Three deaths (two early, one late) occurred due to heart failure. CONCLUSIONS: Cardiac SABR showed reasonable VT suppression in a high-risk population where conventional treatment had failed.