Kawamura Mariko, Shimojo Masafumi, Tatsugami Fuminari, Hirata Kenji, Fujita Shohei, Ueda Daiju, Matsui Yusuke, Fushimi Yasutaka, Fujioka Tomoyuki, Nozaki Taiki, Yamada Akira, Ito Rintaro, Fujima Noriyuki, Yanagawa Masahiro, Nakaura Takeshi, Tsuboyama Takahiro, Kamagata Koji, Naganawa Shinji
Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
J Radiat Res. 2025 Jan 22;66(1):1-9. doi: 10.1093/jrr/rrae090.
Ventricular tachycardia (VT) is a severe arrhythmia commonly treated with implantable cardioverter defibrillators, antiarrhythmic drugs and catheter ablation (CA). Although CA is effective in reducing recurrent VT, its impact on survival remains uncertain, especially in patients with extensive scarring. Stereotactic arrhythmia radioablation (STAR) has emerged as a novel treatment for VT in patients unresponsive to CA, leveraging techniques from stereotactic body radiation therapy used in cancer treatments. Recent clinical trials and case series have demonstrated the short-term efficacy and safety of STAR, although long-term outcomes remain unclear. Imaging techniques, such as electroanatomical mapping, contrast-enhanced magnetic resonance imaging and nuclear imaging, play a crucial role in treatment planning by identifying VT substrates and guiding target delineation. However, challenges persist owing to the complex anatomy and variability in target volume definitions. Advances in imaging and artificial intelligence are expected to improve the precision and efficacy of STAR. The exact mechanisms underlying the antiarrhythmic effects of STAR, including potential fibrosis and improvement in cardiac conduction, are still being explored. Despite its potential, STAR should be cautiously applied in prospective clinical trials, with a focus on optimizing dose delivery and understanding long-term outcomes. Collaborative efforts are necessary to standardize treatment strategies and enhance the quality of life for patients with refractory VT.
室性心动过速（VT）是一种严重的心律失常，通常采用植入式心脏复律除颤器、抗心律失常药物和导管消融（CA）进行治疗。尽管CA在减少VT复发方面有效，但其对生存率的影响仍不确定，尤其是在有广泛瘢痕形成的患者中。立体定向心律失常射频消融（STAR）已成为一种针对对CA无反应的VT患者的新型治疗方法，它利用了癌症治疗中使用的立体定向体部放射治疗技术。最近的临床试验和病例系列已经证明了STAR的短期疗效和安全性，尽管长期结果仍不明确。成像技术，如电解剖标测、对比增强磁共振成像和核成像，通过识别VT基质和指导靶点勾画，在治疗计划中起着关键作用。然而，由于复杂的解剖结构和靶点体积定义的变异性，挑战依然存在。预计成像和人工智能的进展将提高STAR的精度和疗效。STAR抗心律失常作用的具体机制，包括潜在的纤维化和心脏传导的改善，仍在探索中。尽管有潜力，但STAR应在前瞻性临床试验中谨慎应用，重点是优化剂量输送和了解长期结果。需要共同努力来规范治疗策略，提高难治性VT患者的生活质量。
