Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort

Claudia Herrera Siklody, Luis Schiappacasse, Raphaël Jumeau, Tobias Reichlin, Ardan M. Saguner, Nicolaus Andratschke, Olgun Elicin, Frederic Schreiner, Boldizsar Kovacs, Michael Mayinger, Adrian Huber, Joost J. C. Verhoeff, Patrizio Pascale, Jorge Solana Muñoz, Adrian Luca, Giulia Domenichini, Raphael Moeckli, Jean Bourhis, Esat M. Ozsahin, Etienne Pruvot

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Abstract

Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a and results history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude.
Original languageEnglish
Article numbereuad268
JournalEuropace
Volume25
Issue number10
DOIs
Publication statusPublished - 1 Oct 2023
Externally publishedYes

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