The integration of electroanatomic maps into cardiac radioablation treatment planning: A systematic review

Ventricular tachycardia is a life-threatening cardiac arrhythmia for which radiation therapy is an emerging therapeutic option. Electroanatomic maps (EAMs) are used to define clinical target volumes (CTVs) in cardiac radioablation (CRA) treatment planning. Treatment planning systems are unable to integrate EAM data, thus many different workflows have been developed to guide clinicians in CTV creation.

To provide a review of existing CTV definition protocols involving EAM integration for CRA.

PubMed was searched on January 11, 2024, using appropriate search terms. Results were filtered according to inclusion and exclusion criteria following PRISMA guidelines. Results were manually sorted based on their workflow.

The original literature search resulted in 271 search results, to which two hand-selected articles were added. 85 of the resulting articles met inclusion criteria and did not meet exclusion criteria. The reviewed protocols included side-by-side approaches for EAM integration into the treatment planning workflow as well as software-based protocols. Software-based protocols were further subcategorized based on whether the workflows used commercial or non-commercial software to aid in CTV definition.

There is a strong desire to provide solutions for EAM integration into CRA CTV definition protocols. Although single center-specific approaches exist, there is no standardized workflow to address this problem. As the field of CRA grows, standardized workflows and guidelines will be necessary to perform meaningful analyses and comparisons of data between small data sets and to make recommendations for both technical and therapeutic indications.