Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort

Abstract Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. M...

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Veröffentlicht in:	Europace (London, England) England), 2023-10, Vol.25 (10)
Hauptverfasser:	Herrera Siklody, Claudia, Schiappacasse, Luis, Jumeau, Raphaël, Reichlin, Tobias, Saguner, Ardan M, Andratschke, Nicolaus, Elicin, Olgun, Schreiner, Frederic, Kovacs, Boldizsar, Mayinger, Michael, Huber, Adrian, Verhoeff, Joost J C, Pascale, Patrizio, Solana Muñoz, Jorge, Luca, Adrian, Domenichini, Giulia, Moeckli, Raphael, Bourhis, Jean, Ozsahin, Esat M, Pruvot, Etienne
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Schlagworte:	Clinical Research
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creator	Herrera Siklody, Claudia Schiappacasse, Luis Jumeau, Raphaël Reichlin, Tobias Saguner, Ardan M Andratschke, Nicolaus Elicin, Olgun Schreiner, Frederic Kovacs, Boldizsar Mayinger, Michael Huber, Adrian Verhoeff, Joost J C Pascale, Patrizio Solana Muñoz, Jorge Luca, Adrian Domenichini, Giulia Moeckli, Raphael Bourhis, Jean Ozsahin, Esat M Pruvot, Etienne
description	Abstract Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods and results From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude. Graphical Abstract Graphical abstract
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VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods and results From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude. 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VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods and results From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude. 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Schiappacasse, Luis ; Jumeau, Raphaël ; Reichlin, Tobias ; Saguner, Ardan M ; Andratschke, Nicolaus ; Elicin, Olgun ; Schreiner, Frederic ; Kovacs, Boldizsar ; Mayinger, Michael ; Huber, Adrian ; Verhoeff, Joost J C ; Pascale, Patrizio ; Solana Muñoz, Jorge ; Luca, Adrian ; Domenichini, Giulia ; Moeckli, Raphael ; Bourhis, Jean ; Ozsahin, Esat M ; Pruvot, Etienne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c410t-f8cc39e64d48ec61e93cac920bb10f39f7b621dfdd2c8fab75b8aff478e7d1813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Clinical Research</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Herrera Siklody, Claudia</creatorcontrib><creatorcontrib>Schiappacasse, Luis</creatorcontrib><creatorcontrib>Jumeau, Raphaël</creatorcontrib><creatorcontrib>Reichlin, Tobias</creatorcontrib><creatorcontrib>Saguner, Ardan M</creatorcontrib><creatorcontrib>Andratschke, Nicolaus</creatorcontrib><creatorcontrib>Elicin, Olgun</creatorcontrib><creatorcontrib>Schreiner, Frederic</creatorcontrib><creatorcontrib>Kovacs, Boldizsar</creatorcontrib><creatorcontrib>Mayinger, Michael</creatorcontrib><creatorcontrib>Huber, Adrian</creatorcontrib><creatorcontrib>Verhoeff, Joost J C</creatorcontrib><creatorcontrib>Pascale, Patrizio</creatorcontrib><creatorcontrib>Solana Muñoz, Jorge</creatorcontrib><creatorcontrib>Luca, Adrian</creatorcontrib><creatorcontrib>Domenichini, Giulia</creatorcontrib><creatorcontrib>Moeckli, Raphael</creatorcontrib><creatorcontrib>Bourhis, Jean</creatorcontrib><creatorcontrib>Ozsahin, Esat M</creatorcontrib><creatorcontrib>Pruvot, Etienne</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Herrera Siklody, Claudia</au><au>Schiappacasse, Luis</au><au>Jumeau, Raphaël</au><au>Reichlin, Tobias</au><au>Saguner, Ardan M</au><au>Andratschke, Nicolaus</au><au>Elicin, Olgun</au><au>Schreiner, Frederic</au><au>Kovacs, Boldizsar</au><au>Mayinger, Michael</au><au>Huber, Adrian</au><au>Verhoeff, Joost J C</au><au>Pascale, Patrizio</au><au>Solana Muñoz, Jorge</au><au>Luca, Adrian</au><au>Domenichini, Giulia</au><au>Moeckli, Raphael</au><au>Bourhis, Jean</au><au>Ozsahin, Esat M</au><au>Pruvot, Etienne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort</atitle><jtitle>Europace (London, England)</jtitle><date>2023-10-05</date><risdate>2023</risdate><volume>25</volume><issue>10</issue><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>Abstract Aims Stereotactic arrhythmia radioablation (STAR) has been recently introduced for the management of therapy-refractory ventricular tachycardia (VT). VT recurrences have been reported after STAR but the mechanisms remain largely unknown. We analysed recurrences in our patients after STAR. Methods and results From 09.2017 to 01.2020, 20 patients (68 ± 8 y, LVEF 37 ± 15%) suffering from refractory VT were enrolled, 16/20 with a history of at least one electrical storm. Before STAR, an invasive electroanatomical mapping (Carto3) of the VT substrate was performed. A mean dose of 23 ± 2 Gy was delivered to the planning target volume (PTV). The median ablation volume was 26 mL (range 14–115) and involved the interventricular septum in 75% of patients. During the first 6 months after STAR, VT burden decreased by 92% (median value, from 108 to 10 VT/semester). After a median follow-up of 25 months, 12/20 (60%) developed a recurrence and underwent a redo ablation. VT recurrence was located in the proximity of the treated substrate in nine cases, remote from the PTV in three cases and involved a larger substrate over ≥3 LV segments in two cases. No recurrences occurred inside the PTV. Voltage measurements showed a significant decrease in both bipolar and unipolar signal amplitude after STAR. Conclusion STAR is a new tool available for the treatment of VT, allowing for a significant reduction of VT burden. VT recurrences are common during follow-up, but no recurrences were observed inside the PTV. Local efficacy was supported by a significant decrease in both bipolar and unipolar signal amplitude. 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title	Recurrences of ventricular tachycardia after stereotactic arrhythmia radioablation arise outside the treated volume: analysis of the Swiss cohort
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