Abstract
Ventricular tachycardia is a frequent cause of mortality after myocardial infarction. Current treatment includes the implantation of cardioverter defibrillators and adjunctive therapies, such as catheter ablation or cardiac surgery. In patients where standard treatment fails, preclinical data showed that radiosurgery ablation of the ectopic substrate might be a viable option. Authors present a case report of cardiac radiosurgery in a patient with malignant ventricular tachycardia. The stereotactic radiosurgery system, CyberKnife, was used; the applied dose was 25 Gy in one fraction. Within the follow-up period of 120 days, no signs of toxicity were noted and no episode of malignant arrhythmia has been detected. This case report demonstrates that stereotactic radiosurgery of recurrent ventricular tachycardia after inefficient catheter ablation might be a viable option for patients unsuitable for cardiosurgical intervention. Further research on this topic is highly warranted.
Highlights
Ventricular tachycardia (VT) is a re-entrant rhythm that causes significant morbidity and mortality after myocardial infarction or other cardiac disease [1]
In our case report study, we describe methodology, toxicity, and results of radiosurgery ablation for patient with malignant arrhythmia
After the end of session, the ECG analysis according to Implantable cardioverter defibrillators (ICDs) memory was performed and no ventricular tachycardia was found
Summary
Ventricular tachycardia (VT) is a re-entrant rhythm that causes significant morbidity and mortality after myocardial infarction or other cardiac disease [1]. In our case report study, we describe methodology, toxicity, and results of radiosurgery ablation for patient with malignant arrhythmia. After the episode of syncope, the ICD-Cardiac Resynchronization Therapy (ICD-CRT) was implanted in January 2013 She was treated with beta-blockers in maximal, well-tolerated dose (amiodarone was contraindicated due to long QT-interval). Because of repetitive arrhythmic storms, other treatment options were evaluated She was not a candidate for cardiac surgery due to severe comorbidity, such as systemic hypertension, paroxysmal atrial fibrillation, diabetes mellitus, chronic pulmonary obstruction disease, and chronic renal dysfunction. Clinical target volume (CTV) included ectopic lesion (the source of arrhythmia) during systole and diastole (internal target volume, ITV); no additional margin for planning target volume (PTV) was added because of high conformity index (1,27) and low average correlation error (Figure 2).
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