Bianchi Stefano, Marchesano Domenico, Magnocavallo Michele, Polselli Marco, di Renzi Paolo, Grimaldi Gianmarco, Cauti Filippo Maria, Borrazzo Cristian, El Gawhary Randa, Bisignani Antonio, Campoli Massimiliano, Castelluccia Alessandra, Porcelli Daniele, Rossi Pietro, Gentile PierCarlo
Arrhythmology Unit, Isola Tiberina-Gemelli Isola Hospital, Rome, Italy.
Radiation Oncology, San Pietro Fatebenefratelli Hospital, Rome, Italy.
JACC Clin Electrophysiol. 2024 Dec;10(12):2569-2580. doi: 10.1016/j.jacep.2024.08.008. Epub 2024 Oct 9.
Stereotactic arrhythmia radioablation (STAR) was introduced to treat ventricular tachycardia (VT) refractory to catheter ablation. No data are now available in the septal VT substrate setting, representing a challenge when using conventional techniques.
This study sought to evaluate the arrhythmic burden in patients with septal VT treated with magnetic resonance-guided STAR (MRgSTAR).
We enrolled consecutive patients with septal VT substrate. The therapy target was achieved by combining anatomic/functional and electrophysiologic information. Patients were treated with a single fraction of 25 Gy adopting MRgSTAR. All patients were clinically followed up, and all implantable cardiac devices were remotely monitored. The efficacy outcome included recurrences of any sustained VT beyond the 6-week blanking period after MRgSTAR. The safety outcome was the incidence of adverse events and atrioventricular block.
We included 11 patients with septal substrate VT (median age: 68 years; Q1-Q3: 64.5-78 years; 100% male). Clinical presentation was an electrical storm in 81.8% of patients. No complications occurred after MRgSTAR, and 6 (54.5%) patients were discharged on the same day of treatment. During a mean follow-up of 12 ± 6 months, the efficacy outcome occurred in 3 (27.3%) cases. A significative reduction of implantable cardioverter-defibrillator (ICD) therapy (23.6 before MRgSTAR vs 1.7 after MRgSTAR; P < 0.001) was observed. Left ventricular ejection fraction increased significantly after treatment (38% [Q1-Q3: 33.5%-42.0%] before MRgSTAR vs 43.8% [Q1-Q3: 35%-47%] after MRgSTAR; P = 0.04). No adverse effects were observed in the implantable cardioverter-defibrillator and lead system; in the 7 patients with preserved atrioventricular conduction, no atrioventricular block was reported.
MRgSTAR represents a safe and effective strategy for treating septal VT.
立体定向心律失常射频消融术（STAR）被引入用于治疗导管消融难治的室性心动过速（VT）。目前在间隔部室性心动过速基质背景下尚无相关数据，这在使用传统技术时是一项挑战。
本研究旨在评估磁共振引导下的STAR（MRgSTAR）治疗间隔部室性心动过速患者的心律失常负担。
我们纳入了连续的间隔部室性心动过速基质患者。通过结合解剖学/功能性和电生理信息实现治疗靶点。采用MRgSTAR对患者进行单次25 Gy的治疗。所有患者均进行临床随访，所有植入式心脏设备均进行远程监测。疗效结果包括MRgSTAR后6周空白期后任何持续性室性心动过速的复发情况。安全性结果是不良事件和房室传导阻滞的发生率。
我们纳入了11例间隔部基质室性心动过速患者（中位年龄：68岁；第一四分位数-第三四分位数：64.5-78岁；100%为男性）。81.8%的患者临床表现为电风暴。MRgSTAR后未发生并发症，6例（54.5%）患者在治疗当天出院。在平均12±6个月的随访期间，3例（27.3%）出现疗效结果。观察到植入式心律转复除颤器（ICD）治疗显著减少（MRgSTAR前为23.6次 vs MRgSTAR后为1.7次；P<0.001）。治疗后左心室射血分数显著增加（MRgSTAR前为38%[第一四分位数-第三四分位数：33.5%-42.0%] vs MRgSTAR后为43.8%[第一四分位数-第三四分位数：35%-47%]；P=0.04）。在植入式心律转复除颤器和导联系统中未观察到不良反应；在7例房室传导功能保留的患者中，未报告房室传导阻滞。
MRgSTAR是治疗间隔部室性心动过速的一种安全有效的策略。
