Department of Cardiovascular Medicine, National Cancer Center Hospital, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan.
J Interv Card Electrophysiol. 2021 Nov;62(2):319-327. doi: 10.1007/s10840-020-00904-w. Epub 2020 Oct 26.
Although catheter ablation is an effective therapy for atrial fibrillation (AF), risks remain and improved efficacy is desired. Stereotactic radiotherapy is a well-established therapy used to noninvasively treat malignancies with precision. We sought to evaluate stereotactic arrhythmia radioablation (STAR) as a therapeutic option for treating AF.
Three cancer patients with drug refractory AF were enrolled. Planning software using 3-D CT of the left atrium was used to design a desired ablation volume encompassing antral circumferential pulmonary vein isolation, roof and floor lines to create a "box" lesion set. After planning, patients were treated in the radioablation suite. STAR was able to deliver the intended radiation dose to the target in all 3 patients. No complications were observed over a follow-up period of 24 months. One patient with paroxysmal AF died from deterioration of cancer. The autopsy revealed evidence of fibroblasts and fibrogenesis in the region of atrial tissues targeted with radioablation. In one of these patients, left atrial posterior wall electrograms recorded from the esophagus before and 3 months after STAR indicated successful electrical isolation.
This is the first report of non-invasive radioablation of the left atrium with demonstration of successful electrical isolation. Although STAR may be safe and effective in delivering ablative energy to the left atrium, further evaluation is warranted regarding effectiveness.
尽管导管消融是治疗心房颤动（房颤）的有效方法，但仍存在风险，需要提高疗效。立体定向放射治疗是一种成熟的治疗方法，用于精确地非侵入性治疗恶性肿瘤。我们试图评估立体定向心律失常放射消融（STAR）作为治疗房颤的一种治疗选择。
纳入了 3 名患有药物难治性房颤的癌症患者。使用左心房的 3-D CT 规划软件来设计所需的消融体积，包括窦房结环周肺静脉隔离、房顶和地板线，以创建一个“盒子”样病变集。规划完成后，患者在放射消融室接受治疗。STAR 能够在所有 3 名患者中向目标部位输送预期的辐射剂量。在 24 个月的随访期间未观察到任何并发症。1 名患有阵发性房颤的患者因癌症恶化而死亡。尸检显示，在接受放射消融治疗的心房组织区域有纤维母细胞和纤维化的证据。在其中一名患者中，在 STAR 治疗前后从食管记录的左心房后壁电图显示成功的电隔离。
这是首次报道使用非侵入性左心房放射消融术成功实现电隔离。尽管 STAR 可能在向左心房输送消融能量方面是安全有效的，但仍需要进一步评估其有效性。
