Levis Mario, Dusi Veronica, Magnano Massimo, Cerrato Marzia, Gallio Elena, Depaoli Alessandro, Ferraris Federico, De Ferrari Gaetano Maria, Ricardi Umberto, Anselmino Matteo
Department of Oncology, University of Turin, Turin, Italy.
Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
Front Cardiovasc Med. 2022 Aug 22;9:934686. doi: 10.3389/fcvm.2022.934686. eCollection 2022.
Catheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation.
We hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis.
Our case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile.
导管消融（CA）是药物难治性单形性室性心动过速（MMVT）患者当前的标准治疗方法。然而，尽管技术有了显著改进，但复发仍然很常见，导致发病率和死亡率增加。立体定向心律失常射频消融（STAR）越来越多地被采用以克服传统CA的局限性，但其安全性和有效性仍在评估中。
我们在此介绍一名73岁的患者，该患者植入了二尖瓣假体、心脏再同步治疗除颤器和心脏收缩力调节装置，在晚期心力衰竭和巨大左心房的情况下，因复发性药物难治性和CA难治性MMVT接受STAR治疗并取得成功。我们报告了2年的随访情况以及详细的剂量学分析。
我们的病例报告支持单次25 Gy STAR的早期及长期疗效。尽管伴有严重心力衰竭，心脏总体积减去计划靶体积的平均剂量低于5 Gy，但未检测到重大有害心脏副作用。据我们所知，我们的剂量学分析是迄今为止在STAR治疗中报告的最准确的分析，特别是在涉及心脏亚结构和冠状动脉方面。在未来，各开展STAR治疗的中心之间共享剂量学规划对于充分揭示其安全性至关重要。
