Molon Giulio, Giaj-Levra Niccolò, Costa Alessandro, Bonapace Stefano, Cuccia Francesco, Marinelli Alessio, Trachanas Konstantinos, Sicignano Gianluisa, Alongi Filippo
Cardiology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy.
Eur Heart J Suppl. 2022 May 18;24(Suppl C):C248-C253. doi: 10.1093/eurheartj/suac016. eCollection 2022 May.
Stereotactic ablative body radiotherapy (SABR) is an innovative therapeutic approach in patients (pts) with a diagnosis of refractory ventricular tachyarrhythmia (VT) after the use of drugs, radiofrequency catheter ablation, and/or defibrillator (ICD) implant. The current efficacy data of SABR are limited and several prospective clinical studies are ongoing to support the use of ablative radiation dose to control VT. The aim of the current prospective pilot study is to report the efficacy and tolerability of SABR in ICD implanted pts with refractory VT in our centre. Non-invasive electroanatomical mapping (EAM), cardiac computed tomography (CT), and F-fluorodeoxyglucose positron emission (FDG-PET)-CT scan were used and combined with a radiation CT scan. A dose prescription of 25 Gy in a single dose was delivered by volumetric modulated arc therapy (VMAT) Linac-based. The primary endpoint was efficacy, defined as a reduction in ICD shocks after SABR treatment, while the secondary endpoint was safety. Six consecutive pts (five males and one female) implanted with an ICD and with three or more VT were enrolled. One pts died after 1 month, due to end-stage heart failure. Two pts experienced ICD shocks in VT 2 and 5 months after treatment. Three pts experienced no more ICD shocks on VT after therapy. Our data suggest the efficacy and safety of SABR treatment in pts with VT. Larger dataset of pts and longer follow-up are otherwise required to validate the impact of SABR as a standardized treatment in these pts.
立体定向消融体部放疗（SABR）是一种创新的治疗方法，用于那些在使用药物、射频导管消融和/或植入除颤器（ICD）后仍诊断为难治性室性心律失常（VT）的患者。目前SABR的疗效数据有限，正在进行多项前瞻性临床研究以支持使用消融辐射剂量来控制VT。本前瞻性试点研究的目的是报告SABR在我们中心植入ICD的难治性VT患者中的疗效和耐受性。使用了非侵入性电解剖标测（EAM）、心脏计算机断层扫描（CT）和F-氟脱氧葡萄糖正电子发射（FDG-PET）-CT扫描，并与放射CT扫描相结合。基于直线加速器的容积调强弧形治疗（VMAT）单次给予25 Gy的剂量处方。主要终点是疗效，定义为SABR治疗后ICD电击次数减少，次要终点是安全性。连续纳入6例植入ICD且发生3次或更多次VT的患者（5例男性和1例女性）。1例患者在1个月后因终末期心力衰竭死亡。2例患者在治疗后2个月和5个月时经历了VT的ICD电击。3例患者在治疗后未再经历VT的ICD电击。我们的数据表明SABR治疗VT患者的有效性和安全性。否则，需要更大的患者数据集和更长的随访时间来验证SABR作为这些患者标准化治疗的影响。
