Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
Amsterdam UMC location University of Amsterdam, Department of Cardiology, Meibergdreef 9, Amsterdam, the Netherlands.
Radiother Oncol. 2023 Dec;189:109910. doi: 10.1016/j.radonc.2023.109910. Epub 2023 Sep 12.
Stereotactic arrhythmia radioablation (STAR) appears to be beneficial in selected patients with therapy-refractory ventricular tachycardia (VT). However, high-dose radiotherapy used for STAR-treatment may affect functioning of the patients' implantable cardioverter defibrillator (ICD) by direct effects of radiation on ICD components or cardiac tissue. Currently, the effect of STAR on ICD functioning remains unknown.
A retrospective pre-post multicenter study evaluating ICD functioning in the 12-month before and after STAR was performed. Patients with (non)ischemic cardiomyopathies with therapy-refractory VT and ICD who underwent STAR were included and the occurrence of ICD-related adverse events was collected. Evaluated ICD parameters included sensing, capture threshold and impedance. A linear mixed-effects model was used to investigate the association between STAR, radiotherapy dose and changes in lead parameters over time.
In total, 43 patients (88% male) were included in this study. All patients had an ICD with an additional right atrial lead in 34 (79%) and a ventricular lead in 17 (40%) patients. Median ICD-generator dose was 0.1 Gy and lead tip dose ranged from 0-32 Gy. In one patient (2%), a reset occurred during treatment, but otherwise, STAR and radiotherapy dose were not associated with clinically relevant alterations in ICD leads parameters.
STAR treatment did not result in major ICD malfunction. Only one radiotherapy related adverse event occurred during the study follow-up without patient harm. No clinically relevant alterations in ICD functioning were observed after STAR in any of the leads. With the reported doses STAR appears to be safe.
立体定向心律失常放射消融术（STAR）似乎对治疗抵抗性室性心动过速（VT）的选定患者有益。然而，用于 STAR 治疗的高剂量放射治疗可能会通过辐射对 ICD 组件或心脏组织的直接影响来影响患者植入式心脏复律除颤器（ICD）的功能。目前，STAR 对 ICD 功能的影响尚不清楚。
进行了一项回顾性的前后多中心研究，评估了 STAR 前后 12 个月内 ICD 的功能。纳入了患有（非）缺血性心肌病伴治疗抵抗性 VT 和 ICD 的患者，并进行了 STAR，收集了 ICD 相关不良事件的发生情况。评估的 ICD 参数包括感知、捕获阈值和阻抗。使用线性混合效应模型来研究 STAR、放射治疗剂量与随时间变化的导线参数之间的关系。
本研究共纳入 43 名患者（88%为男性）。所有患者均有 ICD，其中 34 名（79%）患者有附加右心房导联，17 名（40%）患者有心室导联。ICD 发生器剂量中位数为 0.1 Gy，导联尖端剂量范围为 0-32 Gy。在 1 名患者（2%）中，在治疗过程中发生了重置，但除此之外，STAR 和放射治疗剂量与 ICD 导联参数的临床相关改变无关。
STAR 治疗并未导致主要的 ICD 故障。在研究随访期间仅发生了 1 例与放射治疗相关的不良事件，并未对患者造成伤害。在任何导联中，STAR 后均未观察到 ICD 功能的临床相关改变。在报告的剂量范围内，STAR 似乎是安全的。
