Focus on stereotactic radiotherapy: A new way to treat severe ventricular arrhythmias?

Frédéric Sacher, Estelle Gandjbakhch, Philippe Maury, Catherine Jenny, Jonathan Khalifa, Serge Boveda, Pascal Defaye, Daniel Gras, Didier Klug, Gabriel Laurent, Nicolas Lellouche, Jacques Mansourati, Eloi Marijon, Olivier Piot, Jerome Taieb, Hubert Cochet, Philippe Maingon, Etienne Pruvot, Laurent Fauchier
Archives of Cardiovascular Diseases 2021 January 18
Ventricular tachycardia has a significant recurrence rate after ablation for several reasons, including inaccessible substrate. A non-invasive technique to ablate any defined areas of myocardium involved in arrhythmogenesis would be a potentially important therapeutic improvement if shown to be safe and effective. Early feasibility studies of single-fraction stereotactic body radiotherapy have demonstrated encouraging results, but rigorous evaluation and follow-up are required. In this document, the basic concepts of stereotactic body radiotherapy are summarized, before focusing on stereotactic arrhythmia radioablation. We describe the effect of radioablation on cardiac tissue and its interaction with intracardiac devices, depending on the dose. The different clinical studies on ventricular tachycardia radioablation are analysed, with a focus on target identification, which is the key feature of this approach. Our document ends with the indications and requirements for practicing this type of procedure in 2020. Finally, because of the limited number of patients treated so far, we encourage multicentre registries with long-term follow-up.

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