针对治疗抵抗性室性心动过速的心脏立体定向体部放疗推荐建议。
Recommendations regarding cardiac stereotactic body radiotherapy for treatment refractory ventricular tachycardia.
机构信息
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany.
出版信息
Heart Rhythm. 2021 Dec;18(12):2137-2145. doi: 10.1016/j.hrthm.2021.08.004. Epub 2021 Aug 8.
BACKGROUND
Ventricular tachycardia (VT) is a potentially lethal complication of structural heart disease. Despite optimal management, a subgroup of patients continue to suffer from recurrent VT. Recently, cardiac stereotactic body radiotherapy (CSBRT) has been introduced as a treatment option in patients with VT refractory to antiarrhythmic drugs and catheter ablation.
OBJECTIVE
The purpose of this study was to establish an expert consensus regarding the conduct and use of CSBRT for refractory VT.
METHODS
We conducted a modified Delphi process. Thirteen experts from institutions from Germany and Switzerland participated in the modified Delphi process. Statements regarding the following topics were generated: treatment setting, institutional expertise and technical requirements, patient selection, target volume definition, and monitoring during and after CSBRT. Agreement was rated on a 5-point Likert scale. The strength of agreement was classified as strong agreement (≥80%), moderate agreement (≥66%) or no agreement (<66%).
RESULTS
There was strong agreement regarding the experimental status of the procedure and the preference for treatment in clinical trials. CSBRT should be conducted at specialized centers with a strong expertise in the management of patients with ventricular arrhythmias and in stereotactic body radiotherapy for moving targets. CSBRT should be restricted to patients with refractory VT with optimal antiarrhythmic medication who underwent prior catheter ablation or have contraindications. Target volume delineation for CSBRT is complex. Therefore, interdisciplinary processes that should include cardiology/electrophysiology and radiation oncology as well as medical physics, radiology, and nuclear medicine are needed. Optimal follow-up is required.
CONCLUSION
Prospective trials and pooled registries are needed to gain further insight into this promising treatment option for patients with refractory VT.
背景
室性心动过速（VT）是结构性心脏病的一种潜在致命并发症。尽管进行了最佳治疗，但仍有一部分患者持续出现复发性 VT。最近，心脏立体定向体部放射治疗（CSBRT）已作为药物和导管消融治疗无效的 VT 患者的一种治疗选择被引入。
目的
本研究旨在就 CSBRT 治疗难治性 VT 的实施和使用达成专家共识。
方法
我们进行了一项改良 Delphi 研究。来自德国和瑞士机构的 13 名专家参与了改良 Delphi 研究。就以下主题生成了陈述：治疗环境、机构专业知识和技术要求、患者选择、靶区定义以及 CSBRT 期间和之后的监测。采用 5 分 Likert 量表对一致性进行评分。一致性的强弱程度分为强烈一致（≥80%）、中度一致（≥66%）或无一致（＜66%）。
结果
对于该程序的实验状态和临床试验中的治疗偏好，专家们存在强烈一致的意见。CSBRT 应在具有处理室性心律失常和立体定向体部放疗移动靶区专业知识的专门中心进行。CSBRT 应限于接受过最佳抗心律失常药物治疗、先前接受过导管消融或有禁忌症的难治性 VT 患者。CSBRT 的靶区勾画复杂，因此需要包括心脏病学/电生理学和放射肿瘤学以及医学物理学、放射学和核医学在内的跨学科流程。需要进行最佳随访。
结论
需要前瞻性试验和汇总登记处来进一步了解这种对难治性 VT 患者有希望的治疗选择。
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