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Stereotactic Ablative radiation therapy (SABR) for cardiac arrhythmia: A new therapeutic option?

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Abstract

Aim

Stereotactic ablative radiation therapy (SABR) is used in non-oncologic indications, recently even for cardiac arrhythmias. Thus, aim of this analysis is to review preclinical, early clinical evidences and future direction of the latter new treatment approach.

Method

A collection of available data regarding SABR and cardiac arrhythmias was made, by Pubmed research and 2 independent researchers, including preclinical and clinical data. A review of ongoing trials was conducted on ClinicalTrials.gov.

Results

Preclinical research conducted in animal models showed that a safe and effective noninvasive treatment approach for cardiac arrhythmias could be represented by SABR with a median time of response around 2–3 months. The treatment dose plays a crucial role: the atrioventricular node would seem more radiosensitive than the other cardiac electric zones. Clinical data, such as published case series, case reports and early prospective studies, have already suggested the feasibility, efficacy and safety of SABR (25 Gy in one session) for refractory ventricular arrhythmias.

Conclusion

Considering the ongoing trials of SABR and new technological improvements in radiotherapy (e.g. hybrid magnetic resonance) and in arrhythmias noninvasive mapping systems, the future analyses will improve the reliability of those preliminary results.

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References

  1. Ponikowski P, Voors AA, Anker SD et al (2016) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200

    Article  Google Scholar 

  2. Zecchin M, Severgnini M, Fiorentino A et al (2018) Management of patients with cardiac implantable electronic devices (CIED) undergoing radiotherapy: a consensus document from Associazione Italiana Aritmologia e Cardiostimolazione (AIAC), Associazione Italiana Radioterapia Oncologica (AIRO), Associazione Italiana Fisica Medica (AIFM). Int J Cardiol 15(255):175–183

    Article  Google Scholar 

  3. Ernst S (2017) Catheter ablation: general principles and advances. Card Electrophysiol Clin 9(2):311–317

    Article  Google Scholar 

  4. Romero J, Shivkumar K, Di Biase L et al (2019) Mastering the art of epicardial access in cardiac electrophysiology. Heart Rhythm 16(11):1738–1749

    Article  Google Scholar 

  5. Leksell L (1951) The stereotactic method and radiosurgery of the brain. Acta Chir Scand 102:316–319

    CAS  PubMed  Google Scholar 

  6. Mazzola R, Fersino S, Alongi P et al (2018) Stereotactic body radiation therapy for liver oligometastases: predictive factors of local response by 18F-FDG-PET/CT. Br J Radiol 91(1088):20180058

    Article  Google Scholar 

  7. Mazzola R, Fersino S, Aiello D et al (2018) Linac-based stereotactic body radiation therapy for unresectable locally advanced pancreatic cancer: risk-adapted dose prescription and image-guided delivery. Strahlenther Onkol 194(9):835–842

    Article  Google Scholar 

  8. Alongi F, Mazzola R, Fiorentino A et al (2019) Phase II study of accelerated Linac-based SBRT in five consecutive fractions for localized prostate cancer. Strahlenther Onkol 195(2):113–120

    Article  Google Scholar 

  9. Franco P, De Bari B, Ciammella P (2014) The role of stereotactic ablative radiotherapy in oncological and non-oncological clinical settings: highlights from the 7th meeting of AIRO–Young Members Working Group (AIRO Giovani). Tumori 100(6):214–219

    Article  Google Scholar 

  10. Graeff C, Bert C (2018) Noninvasive cardiac arrhythmia ablation with particle beams. Med Phys 45(11):e1024–e1035

    Article  Google Scholar 

  11. Song CW, Cho LC, Yuan J et al (2013) Radiobiology of stereotactic body radiation therapy/stereotactic radiosurgery and the linear-quadratic model. Int J Radiat Oncol Biol Phys 87(1):18–19

    Article  Google Scholar 

  12. Shimohigashi Y, Doi Y, Kouno Y et al (2019) Image quality evaluation of in-treatment four-dimensional cone-beam computed tomography in volumetric-modulated arc therapy for stereotactic body radiation therapy. Phys Med 68:10–16

    Article  Google Scholar 

  13. Constantinescu A, Lehmann H, Packer D, Bert C, Durante M, Graeff C (2016) Treatment planning studies in patient data with scanned carbon ion beams for catheter-free ablation of atrial fibrillation. J Cardiovasc Electrophysiol 27:335–344

    Article  Google Scholar 

  14. Bert C, Durante M (2011) Motion in radiotherapy: particle therapy. Phys Med Biol 56:R113–R144

    Article  CAS  Google Scholar 

  15. Verma V, Mishra MV, Mehta MP (2016) A systematic review of the cost and cost-effectiveness studies of proton radiotherapy. Cancer 122(10):1483–1501

    Article  Google Scholar 

  16. Sharma A, Wong D, Weidlich G et al (2010) Noninvasive stereotactic radiosurgery (CyberHeart) for creation of ablation lesions in the atrium. Heart Rhythm 7(6):802–810

    Article  Google Scholar 

  17. Blanck O, Bode F, Gebhard M et al (2014) Dose-escalation study for cardiac radiosurgery in a porcine model. Int J Radiat Oncol Biol Phys 89(3):590–598

    Article  Google Scholar 

  18. Bode F, Blanck O, Gebhard M et al (2015) Pulmonary vein isolation by radiosurgery: implications for non-invasive treatment of atrial fibrillation. Europace 17(12):1868–1874

    Article  Google Scholar 

  19. Lehmann HI, Richter D, Prokesch H et al (2015) Atrioventricular node ablation in Langendorff-perfused porcine hearts using carbon ion particle therapy: methods and an in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias. Circ Arrhythm Electrophysiol 8:429–438

    Article  CAS  Google Scholar 

  20. Lehmann HI, Deisher AJ, Takami M et al (2017) External arrhythmia ablation using photon beams: ablation of the atrioventricular junction in an intact animal model. Circ Arrhythm Electrophysiol 10:e004304

    Article  Google Scholar 

  21. Refaat MM, Ballout JA, Zakka P et al (2017) Swine atrioventricular node ablation using stereotactic radiosurgery: methods and in vivo feasibility investigation for catheter-free ablation of cardiac arrhythmias. J Am Heart Assoc 6(11):e007193

    Article  Google Scholar 

  22. Cuculich PS, Schill MR, Kashani R et al (2017) Noninvasive cardiac radiation for ablation of ventricular tachycardia. N Engl J Med 377(24):2325–2336

    Article  Google Scholar 

  23. Loo BW Jr, Soltys SG, Wang L et al (2015) Stereotactic ablative radiotherapy for the treatment of refractory cardiac ventricular arrhythmia. Circ Arrhythm Electrophysiol 8:748–750

    Article  Google Scholar 

  24. Jumeau R, Ozsahin M, Schwitter J et al (2018) Rescue procedure for an electrical storm using robotic non-invasive cardiac radio-ablation. Radiother Oncol 128(2):189–191

    Article  Google Scholar 

  25. Stöhr EJ, Shave RE, Baggish AL, Weiner RB (2016) Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 311(3):H633–H644

    Article  Google Scholar 

  26. Robinson CG, Samson PP, Moore KMS et al (2019) Phase I/II trial of electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia. Circulation 139:313–321

    Article  Google Scholar 

  27. Cvek J, Neuwirth R, Knybel L et al (2014) Cardiac radiosurgery for malignant ventricular tachycardia. Cureus 6:e190

    Google Scholar 

  28. Zei PC, Mak R (2019) Noninvasive stereotactic radioablation for ventricular tachycardia ENCORE-VT (EP-guided noninvasive cardiac radioablation): is the sequel as good as the original? Circulation 139:322–324

    Article  Google Scholar 

  29. Cochet H, Komatsu Y, Sacher F, Jadidi AS, Scherr D, Riffaud M, Derval N et al (2013) Integration of merged delayed-enhanced magnetic resonance imaging and multidetector computed tomography for the guidance of ventricular tachycardia ablation: a pilot study. J Cardiovasc Electrophysiol 24(4):419–426

    Article  Google Scholar 

  30. Ipsen S, Blanck O, Oborn B et al (2014) Radiotherapy beyond cancer: target localization in real-time MRI and treatment planning for cardiac radiosurgery. Med Phys 41(12):120702

    Article  CAS  Google Scholar 

  31. Franzone P, Fiorentino A, Barra S, Cante D, Masini L, Cazzulo E, Todisco L, Gabriele P, Garibaldi E, Merlotti A, Redda MG, Alongi F, Corvò R (2016) Image-guided radiation therapy (IGRT): practical recommendations of Italian Association of Radiation Oncology (AIRO). Radiol Med 121(12):958–965

    Article  Google Scholar 

  32. Mayinger M, Kovacs B, Tanadini-Lang S et al (2020) First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia. Radiother Oncol. https://doi.org/10.1016/j.radonc.2020.01.008

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, General Regional Hospital “F. Miulli”, Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy

    Alba Fiorentino, Fabiana Gregucci, Ilaria Bonaparte, Alessia Surgo & Roberta Carbonara

  2. Department of Cardiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti, Bari, Italy

    Nicola Vitulano, Antonio Di Monaco, Tommaso Langialonga & Massimo Grimaldi

  3. Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy

    Rosario Mazzola & Filippo Alongi

Authors
  1. Alba Fiorentino
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  2. Fabiana Gregucci
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  3. Ilaria Bonaparte
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  4. Nicola Vitulano
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Correspondence to Fabiana Gregucci.

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Fiorentino, A., Gregucci, F., Bonaparte, I. et al. Stereotactic Ablative radiation therapy (SABR) for cardiac arrhythmia: A new therapeutic option?. Radiol med 126, 155–162 (2021). https://doi.org/10.1007/s11547-020-01218-7

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  • DOI: https://doi.org/10.1007/s11547-020-01218-7

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