Redpath Calum J, Crean Andrew M, Nery Pablo B, Nair Girish M, Golian Mehrdad, Hansom Simon, Haberl Connor, deKemp Robert, Cuculich Phillip S, Robinson Clifford G, Lekx-Toniolo Katie S, Tiberi David, Cook Graham
Division of Cardiology, The University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Center for Noninvasive Cardiac Radioablation, Washington University, St Louis, Missouri, USA.
CJC Open. 2025 Jan 23;7(5):545-554. doi: 10.1016/j.cjco.2025.01.015. eCollection 2025 May.
Patients who have recurrent ventricular tachycardia (VT) despite receiving antiarrhythmic drugs (AADs), implantable cardioverter defibrillator placement, and catheter ablation (CA) are at significant risk of morbidity and mortality.
We offered completely noninvasive cardiac radio-ablation (CRA) on a "compassionate use" basis for patients who were unable or unwilling to undergo CA for recurrent VT despite their having received treatment with AADs and placement of an implantable cardioverter defibrillator. All patients who were referred to the CRA program were entered into a prospective registry and followed indefinitely thereafter.
A total of 20 patients were referred for CRA, and 10 elected to undergo the treatment as outpatients. Ten patients declined CRA therapy, owing to fear of complications and/or logistic concerns relating to attending multiple hospital visits; they received escalated drug therapy. All patients who were referred to and were agreeable to CRA received CRA. No patients were excluded or were denied CRA by clinicians for any reason, and all patients were followed clinically. The VT burden decreased significantly, by > 90% (both anti-tachycardia pacing and shocks), and 1 patient died of a cardiovascular cause at 1 year following a single CRA treatment of 25 Gy. One patient experienced steroid-responsive pneumonitis as an adverse event post-CRA (common terminology criteria for adverse events [CTCAE] grade 2). For the 10 patients who declined CRA, no appreciable reduction in VT occurred, despite their receipt of increasing dosages of AADs, and 5 patients died of cardiovascular causes within 1 year.
Noninvasive stereotactic CRA is well tolerated with good short-term efficacy for recurrent VT on a "compassionate use" basis. Prospective randomized controlled trials to determine the relative efficacy of CA vs CRA for VT are urgently required.
尽管接受了抗心律失常药物（AADs）治疗、植入式心脏复律除颤器安置及导管消融（CA），仍发生复发性室性心动过速（VT）的患者存在显著的发病和死亡风险。
对于尽管接受了AADs治疗和植入式心脏复律除颤器安置，但仍因复发性VT而无法或不愿接受CA的患者，我们在“同情用药”的基础上提供完全非侵入性心脏放射消融（CRA）。所有被转诊至CRA项目的患者均被纳入前瞻性登记，并在此后进行无限期随访。
共有20例患者被转诊接受CRA，其中10例选择作为门诊患者接受治疗。10例患者因担心并发症和/或因需多次就诊的后勤问题而拒绝CRA治疗；他们接受了强化药物治疗。所有被转诊并同意接受CRA的患者均接受了CRA。没有患者因任何原因被临床医生排除或拒绝接受CRA，所有患者均接受临床随访。VT负荷显著降低，超过90%（抗心动过速起搏和电击均如此），1例患者在单次25 Gy的CRA治疗后1年死于心血管原因。1例患者在CRA后出现类固醇反应性肺炎这一不良事件（不良事件通用术语标准[CTCAE]2级）。对于10例拒绝CRA的患者，尽管他们接受了剂量增加的AADs治疗，但VT没有明显减少，5例患者在1年内死于心血管原因。
在“同情用药”的基础上，非侵入性立体定向CRA耐受性良好，对复发性VT具有良好的短期疗效。迫切需要进行前瞻性随机对照试验，以确定CA与CRA治疗VT的相对疗效。
