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; Alison Blower; David Scoones; Michele Wilkinson; Neil Richmond; Clifford Robinson; Phillip Cuculich; Geoffrey Hugo; Neil Seller; Ruth McStay; Nicholas Child; Andrew Thornley; Nicholas Kelland; Philip Atherton; Clive Peedell; Matthew Hatton

doi:10.1136/openhrt-2021-001770

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, Alison Blower, David Scoones, Michele Wilkinson, Neil Richmond, Clifford Robinson, Phillip Cuculich, Geoffrey Hugo, Neil Seller, Ruth McStay, Nicholas Child, Andrew Thornley, Nicholas Kelland, Philip AthertonClive Peedell, Matthew Hatton

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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.

Original language	English
Article number	e001770
Journal	Open Heart
Volume	8
Issue number	2
DOIs	https://doi.org/10.1136/openhrt-2021-001770
State	Published - Nov 23 2021

Keywords

ablation techniques
cardiomyopathies
tachycardia
ventricular

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Lee, J., Bates, M., Shepherd, E., Riley, S., Henshaw, M., Metherall, P., Daniel, J., Blower, A., Scoones, D., Wilkinson, M., Richmond, N., Robinson, C., Cuculich, P., Hugo, G., Seller, N., McStay, R., Child, N., Thornley, A., Kelland, N., ... Hatton, M. (2021). Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: Initial UK multicentre experience. Open Heart, 8(2), Article e001770. https://doi.org/10.1136/openhrt-2021-001770

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title = "Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: Initial UK multicentre experience",

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.",

keywords = "ablation techniques, cardiomyopathies, tachycardia, ventricular",

author = "Justin Lee and Matthew Bates and Ewen Shepherd and Stephen Riley and Michael Henshaw and Peter Metherall and Jim Daniel and Alison Blower and David Scoones and Michele Wilkinson and Neil Richmond and Clifford Robinson and Phillip Cuculich and Geoffrey Hugo and Neil Seller and Ruth McStay and Nicholas Child and Andrew Thornley and Nicholas Kelland and Philip Atherton and Clive Peedell and Matthew Hatton",

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year = "2021",

month = nov,

day = "23",

doi = "10.1136/openhrt-2021-001770",

language = "English",

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Lee, J, Bates, M, Shepherd, E, Riley, S, Henshaw, M, Metherall, P, Daniel, J, Blower, A, Scoones, D, Wilkinson, M, Richmond, N, Robinson, C , Cuculich, P , Hugo, G, Seller, N, McStay, R, Child, N, Thornley, A, Kelland, N, Atherton, P, Peedell, C & Hatton, M 2021, 'Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: Initial UK multicentre experience', Open Heart, vol. 8, no. 2, e001770. https://doi.org/10.1136/openhrt-2021-001770

TY - JOUR

T1 - Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia

T2 - Initial UK multicentre experience

AU - Lee, Justin

AU - Bates, Matthew

AU - Shepherd, Ewen

AU - Riley, Stephen

AU - Henshaw, Michael

AU - Metherall, Peter

AU - Daniel, Jim

AU - Blower, Alison

AU - Scoones, David

AU - Wilkinson, Michele

AU - Richmond, Neil

AU - Robinson, Clifford

AU - Cuculich, Phillip

AU - Hugo, Geoffrey

AU - Seller, Neil

AU - McStay, Ruth

AU - Child, Nicholas

AU - Thornley, Andrew

AU - Kelland, Nicholas

AU - Atherton, Philip

AU - Peedell, Clive

AU - Hatton, Matthew

PY - 2021/11/23

Y1 - 2021/11/23

N2 - 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.

AB - 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.

KW - ablation techniques

KW - cardiomyopathies

KW - tachycardia

KW - ventricular

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U2 - 10.1136/openhrt-2021-001770

DO - 10.1136/openhrt-2021-001770

M3 - Article

C2 - 34815300

AN - SCOPUS:85120328918

SN - 2398-595X

VL - 8

JO - Open Heart

JF - Open Heart

IS - 2

M1 - e001770

ER -

Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: Initial UK multicentre experience

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