Clinical Evidence behind Stereotactic Radiotherapy for the Treatment of Ventricular Tachycardia (STAR)-A Comprehensive Review.

Wojciech Wojakowski,Marcin Miszczyk,Krzysztof Gołba,Tomasz Jadczyk,Krystian Wita,Jacek Bednarek,Sławomir Blamek

doi:10.3390/jcm10061238

Abstract

The electrophysiology-guided noninvasive cardiac radioablation, also known as STAR (stereotactic arrhythmia radioablation) is an emerging treatment method for persistent ventricular tachycardia. Since its first application in 2012 in Stanford Cancer Institute, and a year later in University Hospital Ostrava, Czech Republic, the authors from all around the world have published case reports and case series, and several prospective trials were established. In this article, we would like to discuss the available clinical evidence, analyze the potentially clinically relevant differences in methodology, and address some of the unique challenges that come with this treatment method.

Highlights

Ventricular arrhythmias, including ventricular tachycardias (VT), are a major cause of sudden cardiac death (SCD) [1], which globally contributes to 4.25 million deaths every year [2]
The guidelines-driven management of VTs consists of antiarrhythmic drugs (AADs), placement of implantable cardiac defibrillators (ICDs), and the ablation of the arrhythmogenic substrate [3,4,5]
We have found that despite significant artifacts caused by the ICD lead, the positioning of the target volume and cardiac subvolumes is facilitated through the identification of reference points, such as calcified atherosclerotic plaques, abundantly found in the stereotactic arrhythmia radioablation (STAR) patients population (Figure 3)

Summary

Introduction

Ventricular arrhythmias, including ventricular tachycardias (VT), are a major cause of sudden cardiac death (SCD) [1], which globally contributes to 4.25 million deaths every year [2].The guidelines-driven management of VTs consists of antiarrhythmic drugs (AADs), placement of implantable cardiac defibrillators (ICDs), and the ablation of the arrhythmogenic substrate [3,4,5]. Ventricular arrhythmias, including ventricular tachycardias (VT), are a major cause of sudden cardiac death (SCD) [1], which globally contributes to 4.25 million deaths every year [2]. Despite the significant clinical improvement, results of conventional radiofrequency ablation (RFA) strategy can be limited especially in case of challenging anatomy and subepicardial substrate location. 12–17% at 1 year follow-up [6], and, rarely directly associated with procedural complications (0.6%), RFA is associated with up to ~5% short-term mortality in ischemic VT cases [7]. A need to deliver better care for patients makes VT ablations one of the most dynamically growing areas in the field of cardiac electrophysiology (EP) [8]. The increasing number of patients with refractory VT leveraged by the implementation of new technologies has already improved clinical results [9].

Methods

Results

Discussion

Conclusion