Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia: From Serendipity to Precision Biological...

Area of Science:

• Cardiology
• Radiation Oncology
• Medical Physics

Background:

• Refractory ventricular arrhythmias (VAs), especially ventricular tachycardia (VT), present significant treatment challenges with high morbidity and mortality.
• Conventional therapies like antiarrhythmic drugs and catheter ablation (CA) are often ineffective for these patients.

Purpose of the Study:

• To review the clinical evidence for stereotactic arrhythmia radioablation (STAR) as a non-invasive alternative for refractory VAs.
• To explore the biological mechanisms and technical considerations of STAR therapy.

Main Methods:

• Synthesis of data from prospective trials, retrospective series, and case reports on STAR efficacy.
• Review of studies investigating the electrophysiological and structural mechanisms of STAR.
• Analysis of technical aspects including patient selection, imaging, and treatment planning.

Main Results:

• STAR demonstrates efficacy in reducing ventricular tachycardia burden and improving quality of life in patients unresponsive to conventional treatments.
• Evidence suggests STAR involves early electrophysiological reprogramming and delayed structural remodeling via inflammation and fibrosis.
• Key technical considerations for safe and effective STAR delivery have been identified.

Conclusions:

• STAR is a promising non-invasive option for refractory VAs, with encouraging short-term outcomes.
• Further research is required to optimize STAR dosing, techniques, and confirm long-term safety and efficacy.