Michael S Lloyd1, John Wight2, Frank Schneider3, Michael Hoskins2, Tamer Attia4, Chase Escott5, Stamatios Lerakis6, Kristin A Higgins5. 1. Section of Clinical Cardiac Electrophysiology, Emory University, Atlanta, Georgia. Electronic address: Mlloyd2@emory.edu. 2. Section of Clinical Cardiac Electrophysiology, Emory University, Atlanta, Georgia. 3. Division of Anatomic Pathology, Emory University, Atlanta, Georgia. 4. Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. 5. Department of Radiation Oncology, Emory University, Atlanta, Georgia. 6. Division of Cardiology, Mount Sinai Hospital, New York, New York.
Abstract
BACKGROUND: Stereotactic body radiation therapy (SBRT) has been shown to be effective in treating patients with refractory ventricular tachycardia. OBJECTIVE: The purpose of this study was to describe outcomes for SBRT in advanced heart failure patients admitted for repeated implantable cardioverter-defibrillator (ICD) therapies who were refractory to standard treatments. METHODS: SBRT simulation, planning, and treatments were performed using standard techniques with collaboration from a radiation oncologist, electrophysiologist, and cardiac imaging specialist. Patients were treated with single-fraction 25 Gy while awake. Efficacy was assessed by total durations in seconds of ventricular tachycardia, frequency of antitachycardia pacing (ATP), and quantity of shocks before and after treatment as recorded by an ICD. RESULTS: A total of 10 patients (mean age 61 years; 3 female) were included. Etiologies of heart failure were ischemic in 40% (4/10) and nonischemic in 60% (6/10). Among 8 patients with available ICD data, the total reduction in seconds of detected VT was 69% (pretreatment 1065 seconds/month vs posttreatment 332 seconds/month). The total reduction in ATP sequences was 48% (17.3 pretreatment and 8.9 posttreatment). Reduction in total ICD shocks after SBRT was 68% (2.9 shocks/month pretreatment and 0.9 shocks/month posttreatment). When excluding a single nonresponder, there was a significant reduction in VT seconds (94%; P = .04) and a trend toward ICD shock reduction (90%; P = .07) post-SBRT. CONCLUSION: Noninvasive treatment with SBRT was feasible and modestly effective at reducing VT burden in the critically ill. This suggests that SBRT treatment may be a useful palliation for electrical storm.
BACKGROUND: Stereotactic body radiation therapy (SBRT) has been shown to be effective in treating patients with refractory ventricular tachycardia. OBJECTIVE: The purpose of this study was to describe outcomes for SBRT in advanced heart failurepatients admitted for repeated implantable cardioverter-defibrillator (ICD) therapies who were refractory to standard treatments. METHODS: SBRT simulation, planning, and treatments were performed using standard techniques with collaboration from a radiation oncologist, electrophysiologist, and cardiac imaging specialist. Patients were treated with single-fraction 25 Gy while awake. Efficacy was assessed by total durations in seconds of ventricular tachycardia, frequency of antitachycardia pacing (ATP), and quantity of shocks before and after treatment as recorded by an ICD. RESULTS: A total of 10 patients (mean age 61 years; 3 female) were included. Etiologies of heart failure were ischemic in 40% (4/10) and nonischemic in 60% (6/10). Among 8 patients with available ICD data, the total reduction in seconds of detected VT was 69% (pretreatment 1065 seconds/month vs posttreatment 332 seconds/month). The total reduction in ATP sequences was 48% (17.3 pretreatment and 8.9 posttreatment). Reduction in total ICD shocks after SBRT was 68% (2.9 shocks/month pretreatment and 0.9 shocks/month posttreatment). When excluding a single nonresponder, there was a significant reduction in VT seconds (94%; P = .04) and a trend toward ICD shock reduction (90%; P = .07) post-SBRT. CONCLUSION: Noninvasive treatment with SBRT was feasible and modestly effective at reducing VT burden in the critically ill. This suggests that SBRT treatment may be a useful palliation for electrical storm.
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Authors: Justin Lee; Matthew Bates; Ewen Shepherd; Stephen Riley; Michael Henshaw; Peter Metherall; Jim Daniel; Alison Blower; David Scoones; Michele Wilkinson; Neil Richmond; Clifford Robinson; Phillip Cuculich; Geoffrey Hugo; Neil Seller; Ruth McStay; Nicholas Child; Andrew Thornley; Nicholas Kelland; Philip Atherton; Clive Peedell; Matthew Hatton Journal: Open Heart Date: 2021-11