STereotactic Arrhythmia Radioablation and its place in modern cardiac ElectroPhysiology: Results of an EHRA Survey

Abstract

Abstract Background Stereotactic arrhythmia radioablation (STAR) is an emerging treatment option for recurrent ventricular tachycardia/fibrillation (VT/VF) in particular in structural heart disease (SHD). However, the current role and envisioned future role of STAR is in clinical practice as viewed by Cardiologists is unknown. Objective To assess the current role of STAR, barriers to its use, and expected future role, within the cardiology community. Methods An online survey was created with the support of the EHRA Scientific Initiatives committee and distributed via newsletters and social media. The survey consisted of 20 multiple-choice questions with a focus on baseline demographics, awareness / access, current use, and the future role of STAR. Results A total of 129 international participants completed the survey, mean age was 43±11 years, 25 (16.4%) were female. Ninety-one (59.9%) participants were cardiac electrophysiologists while 13 (8.6%) were general cardiologists. Nine participants (7%) were unaware of STAR as a therapeutic option. Sixty-four (49.6%) had access to STAR while 62 (48.1%) had treated / referred a patient for treatment. Median number of patients treated was 4 (range 1-100). Common primary indications for STAR were recurrent VT/VF in SDH (45%), recurrent VT/VF without SHD (7.8%) or PVC (3.9%). Based on their knowledge, 49% and 59% of survey participants responded they would consider performing / referring a patient for STAR, respectively. Reported main advantages of STAR were efficacy in the treatment of arrhythmias not amenable to conventional treatment (49%), non-invasive treatment approach with overall low expected acute and short-term procedural risk (23%) and possible higher efficacy than other available treatment options (23%). Survey respondents named one or more previous catheter ablations (CA) or contraindication for CA (79%), diagnosis of SHD (78%), recurrent monomorphic VT with >3 episodes within the preceding 3 months (68%), optimal antiarrhythmic medication (61%) or electrical storm (59%) as prerequisites for the use of STAR. Most respondents foresee a future clinical role for STAR in the treatment of VT/VF with or without underlying SHD (72% and 75%, respectively). Although, only a minority expected a first-line indication for it in with or without SHD (7% and 5%, respectively) and STAR was viewed rather as a bail-out option (48% and 35%, respectively). Conclusions STAR is a new option for the treatment of recurrent VT that appears to gain acceptance within the EP community. Randomized-controlled trials and an EHRA consensus document are critical to further define efficacy, patient populations, as well as the appropriate clinical use for the treatment of VT.Central figureFuture role of STAR