Shah Keyur D, Chang Chih-Wei, Tian Sibo, Patel Pretesh, Qiu Richard, Roper Justin, Zhou Jun, Tian Zhen, Yang Xiaofeng
Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA.
Department of Radiation & Cellular Oncology, University of Chicago, Chicago, IL.
ArXiv. 2025 May 14:arXiv:2501.18872v2.
Stereotactic arrhythmia radioablation (STAR) is a non-invasive salvage therapy for refractory ventricular tachycardia (VT), especially in patients ineligible for catheter ablation. This narrative review and pooled analysis evaluates the safety, efficacy, and technical characteristics of STAR, integrating preclinical studies, case reports, case series, and clinical trials.
A comprehensive review identified 86 studies published between 2015 and 2025, including 12 preclinical studies, 49 case reports, 18 case series, and 7 clinical trials. Study-level data were extracted for pooled analysis of 6- and 12-month mortality, VT burden reduction, and grade 3+ acute toxicities. Subgroup analyses were performed by delivery modality, age, left ventricular ejection fraction (LVEF), and cardiomyopathy type.
Pooled mortality was 16% (95% CI: 11-20%) at 6 months and 33% (95% CI: 27-38%) at 12 months. VT burden reduction at 6 months averaged 75% (95% CI: 73-77%) but showed substantial heterogeneity (I = 98.8%). Grade 3+ acute toxicities occurred in 7% (95% CI: 4-10%), with heart failure being most common. Subgroup analyses suggested better outcomes in younger patients, those with NICM, and those with higher LVEF.
STAR is a promising salvage therapy with favorable acute safety and efficacy. Outcome heterogeneity and inconsistent reporting highlight the need for standardized definitions, dosimetric protocols, and longer-term follow-up. Prospective trials and real-world registries are critical for refining STAR's role in VT management.
立体定向心律失常射频消融术（STAR）是一种用于难治性室性心动过速（VT）的非侵入性挽救治疗方法，尤其适用于不适合导管消融的患者。本叙述性综述和汇总分析评估了STAR的安全性、有效性和技术特征，整合了临床前研究、病例报告、病例系列和临床试验。
全面检索确定了2015年至2025年间发表的86项研究，包括12项临床前研究、49项病例报告、18项病例系列和7项临床试验。提取研究水平的数据用于汇总分析6个月和12个月的死亡率、VT负荷降低情况以及3级及以上急性毒性反应。按递送方式、年龄、左心室射血分数（LVEF）和心肌病类型进行亚组分析。
6个月时汇总死亡率为16%（95%CI：11-20%），12个月时为33%（95%CI：27-38%）。6个月时VT负荷平均降低75%（95%CI：73-77%），但存在显著异质性（I=98.8%）。3级及以上急性毒性反应发生率为7%（95%CI：4-10%），其中心力衰竭最为常见。亚组分析表明，年轻患者、非缺血性心肌病（NICM）患者和LVEF较高的患者预后较好。
STAR是一种有前景的挽救治疗方法，具有良好的急性安全性和有效性。结果的异质性和报告的不一致性凸显了标准化定义、剂量方案和长期随访的必要性。前瞻性试验和真实世界注册对于明确STAR在VT管理中的作用至关重要。
