Chang Won Ick, Jo Ha Hye, Cha Myung-Jin, Chang Ji Hyun, Choi Chang Heon, Kim Hak Jae, Oh Seil, Robinson Clifford G, Cuculich Phillip S
Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Heart Rhythm O2. 2022 Dec 5;4(2):119-126. doi: 10.1016/j.hroo.2022.11.006. eCollection 2023 Feb.
Noninvasive cardiac radioablation is reported to be effective and safe for the treatment of ventricular tachycardia (VT).
This study aimed to analyze the acute and long-term effects of VT radioablation.
Patients with intractable VT or premature ventricular contraction (PVC)-induced cardiomyopathy were included in this study and treated using a single-fraction 25-Gy dose of cardiac radioablation. To quantitatively analyze the acute response after treatment, continuous electrocardiography monitoring was performed from 24 hours before to 48 hours after irradiation and at the 1-month follow-up. Long-term clinical safety and efficacy were assessed 1-year follow-up.
From 2019 to 2020, 6 patients were treated with radioablation for ischemic VT (n = 3), nonischemic VT (n = 2), or PVC-induced cardiomyopathy (n = 1). In the short-term assessment, the total burden of ventricular beats decreased by 49% within 24 hours after radioablation and further decreased by 70% at 1 month. The VT component decreased earlier and more dramatically than the PVC component (decreased by 91% and 57% at 1 month, respectively). In the long-term assessment, 5 patients showed complete (n = 3) or partial (n = 2) remission of ventricular arrhythmias. One patient showed recurrence at 10 months, which was successfully suppressed with medical treatment. The posttreatment PVC coupling interval was prolonged (+38 ms at 1 month). Ischemic VT burden decreased more markedly than nonischemic VT burden after radioablation.
In this small case series of 6 patients, without a comparison group, cardiac radioablation appeared to decrease the intractable VT burden. A therapeutic effect was apparent within 1-2 days after treatment but was variable by etiology of cardiomyopathy.
据报道，非侵入性心脏放射消融术治疗室性心动过速（VT）有效且安全。
本研究旨在分析VT放射消融术的急性和长期效果。
本研究纳入了难治性VT或室性早搏（PVC）诱发的心肌病患者，并采用单次25 Gy剂量的心脏放射消融术进行治疗。为了定量分析治疗后的急性反应，在照射前24小时至照射后48小时以及1个月随访时进行连续心电图监测。在1年随访时评估长期临床安全性和疗效。
2019年至2020年，6例患者接受了放射消融术治疗，其中缺血性VT（n = 3）、非缺血性VT（n = 2）或PVC诱发的心肌病（n = 1）。在短期评估中，放射消融术后24小时内心室搏动总数减少了49%，1个月时进一步减少了70%。VT成分比PVC成分下降得更早且更显著（1个月时分别下降了91%和57%）。在长期评估中，5例患者的室性心律失常完全（n = 3）或部分（n = 2）缓解。1例患者在10个月时复发，经药物治疗成功抑制。治疗后PVC的联律间期延长（1个月时延长38 ms）。放射消融术后缺血性VT负荷比非缺血性VT负荷下降更明显。
在这个6例患者的小病例系列中，没有对照组，心脏放射消融术似乎降低了难治性VT负荷。治疗后1 - 2天内治疗效果明显，但因心肌病病因不同而有所差异。
