Peichl Petr, Sramko Marek, Cvek Jakub, Kautzner Josef
Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958/9, Prague 140 21, Czech Republic.
Department of Oncology, University Hospital Ostrava, 17. listopadu 1790/5, Ostrava, 708 00, Czech Republic.
Eur Heart J Case Rep. 2020 Dec 27;5(2):ytaa516. doi: 10.1093/ehjcr/ytaa516. eCollection 2021 Feb.
Stereotactic body radiotherapy (SBRT) has emerged recently as a novel therapeutic alternative for patients with ventricular tachycardias (VTs) resistant to convetional treatment. Nevertheless, many aspects related to SBRT are currently unknown.
A 66-year-old man with ischaemic heart disease, a history of coronary artery bypass graft surgery and left ventricular dysfunction was referred for recurrent symptomatic episodes of slow VT (108 b.p.m.). The arrhythmia was resistant to antiarrhythmic drug therapy with amiodarone and repeated catheter ablation. The patient was scheduled to SBRT, however, the first session failed to suppress VT recurrences. After 20 months, the patient underwent re-do ablation procedure that revealed a newly developed scar with its core adjacent to the presumed critical part of the VT substrate. Catheter ablation again failed to eliminate VT and the second session of SBRT was scheduled. To improve targeting of the VT substrate for SBRT, we applied our recently developed original method for integration of data from the electroanatomical mapping system with computer tomography images. The second session of SBRT with precise targeting using the novel strategy led within 3 months to the successful elimination of VT.
This case report describes a patient in whom the recurrent VT was abolished only by properly targeted SBRT. Above all, the case highlights the importance of precise identification and targeting for SBRT. Our case also documents , by electroanatomical voltage mapping, the development of SBRT-related myocardial lesion. This represents an important mechanistic proof of the concept of SBRT.
立体定向体部放疗（SBRT）最近已成为对传统治疗耐药的室性心动过速（VT）患者的一种新型治疗选择。然而，目前与SBRT相关的许多方面尚不清楚。
一名66岁男性，有缺血性心脏病、冠状动脉旁路移植手术史和左心室功能障碍，因缓慢型室性心动过速（108次/分钟）反复发作伴症状前来就诊。心律失常对胺碘酮抗心律失常药物治疗及反复导管消融均耐药。该患者计划接受SBRT治疗，然而，第一次治疗未能抑制室性心动过速复发。20个月后，患者接受再次消融手术，发现新形成的瘢痕，其核心邻近室性心动过速基质的推测关键部位。导管消融再次未能消除室性心动过速，于是安排了第二次SBRT治疗。为了改善SBRT对室性心动过速基质的靶向性，我们应用了最近开发的将电解剖标测系统数据与计算机断层扫描图像整合的原始方法。采用新策略精确靶向的第二次SBRT治疗在3个月内成功消除了室性心动过速。
本病例报告描述了一名仅通过适当靶向的SBRT消除复发性室性心动过速的患者。最重要的是，该病例突出了精确识别和靶向SBRT的重要性。我们的病例还通过电解剖电压标测记录了SBRT相关心肌病变的发展。这代表了SBRT概念的一个重要机制证据。
