Qian Pierre C, Azpiri Jose R, Assad Jose, Gonzales Aceves Eric Noel, Cardona Ibarra Carlos Erick, de la Pena Cuauhtemoc, Hinojosa Miguel, Wong Doug, Fogarty Thomas, Maguire Patrick, Jack Alice, Gardner Edward A, Zei Paul C
Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA USA.
Department of Cardiology Christus Hospital Monterrey Mexico.
J Arrhythm. 2019 Dec 3;36(1):67-74. doi: 10.1002/joa3.12283. eCollection 2020 Feb.
Catheter ablation is an effective therapy for atrial fibrillation (AF). However, risks remain, and improved efficacy is desired. Stereotactic body radiotherapy (SBRT) is a well-established therapy used to noninvasively treat malignancies and functional disorders with precision. We evaluated the feasibility of stereotactic radioablation for treating paroxysmal AF.
Two patients with drug-refractory paroxysmal AF underwent pulmonary vein isolation with SBRT. After placement of a percutaneous active fixation temporary pacing lead tracking fiducial, computed tomography (CT) angiography was performed to define left atrial anatomy. A tailored planning treatment volume was created to deliver contiguous linear ablations to isolate the pulmonary veins and posterior wall. Patients were treated on an outpatient basis in the radioablation suite. Clinical follow-up was performed through at least 24 months after therapy.
Both patients successfully underwent SBRT planning and treatment without significant early or long-term side effects up to 48 months of follow-up. One patient had AF recurrence after 6 months free of arrhythmia, while the second patient remains free of AF after 24 months with fibrosis detected on MRI scan consistent with the ablation lesion set. An incidentally noted small pericardial effusion occurred in one patient.
Stereotactic radioablation may be feasible for the treatment of drug-refractory AF. Further evaluation is warranted.
导管消融是治疗心房颤动（AF）的有效方法。然而，风险依然存在，仍需要提高疗效。立体定向体部放疗（SBRT）是一种成熟的治疗方法，用于以精确的方式无创治疗恶性肿瘤和功能性疾病。我们评估了立体定向射频消融治疗阵发性AF的可行性。
两名药物难治性阵发性AF患者接受了SBRT肺静脉隔离术。在放置经皮主动固定临时起搏导线跟踪基准点后，进行计算机断层扫描（CT）血管造影以确定左心房解剖结构。创建一个定制的计划治疗体积，以进行连续的线性消融，以隔离肺静脉和后壁。患者在射频消融室接受门诊治疗。治疗后至少随访24个月进行临床随访。
两名患者均成功接受了SBRT计划和治疗，在长达48个月的随访中均无明显的早期或长期副作用。一名患者在无心律失常6个月后出现AF复发，而另一名患者在24个月后仍无AF，MRI扫描检测到纤维化，与消融病灶一致。一名患者偶然发现少量心包积液。
立体定向射频消融治疗药物难治性AF可能可行。有必要进行进一步评估。
