Abstract

ABSTRACT

Ventricular tachycardia (VT) is a severe arrhythmia commonly treated with implantable cardioverter defibrillators, antiarrhythmic drugs and catheter ablation (CA). Although CA is effective in reducing recurrent VT, its impact on survival remains uncertain, especially in patients with extensive scarring. Stereotactic arrhythmia radioablation (STAR) has emerged as a novel treatment for VT in patients unresponsive to CA, leveraging techniques from stereotactic body radiation therapy used in cancer treatments. Recent clinical trials and case series have demonstrated the short-term efficacy and safety of STAR, although long-term outcomes remain unclear. Imaging techniques, such as electroanatomical mapping, contrast-enhanced magnetic resonance imaging and nuclear imaging, play a crucial role in treatment planning by identifying VT substrates and guiding target delineation. However, challenges persist owing to the complex anatomy and variability in target volume definitions. Advances in imaging and artificial intelligence are expected to improve the precision and efficacy of STAR. The exact mechanisms underlying the antiarrhythmic effects of STAR, including potential fibrosis and improvement in cardiac conduction, are still being explored. Despite its potential, STAR should be cautiously applied in prospective clinical trials, with a focus on optimizing dose delivery and understanding long-term outcomes. Collaborative efforts are necessary to standardize treatment strategies and enhance the quality of life for patients with refractory VT.

Details

Title
Stereotactic arrhythmia radioablation for ventricular tachycardia: a review of clinical trials and emerging roles of imaging
Author
Kawamura, Mariko 1 ; Shimojo, Masafumi 2 ; Tatsugami, Fuminari 3 ; Hirata, Kenji 4 ; Fujita, Shohei 5 ; Ueda, Daiju 6 ; Matsui, Yusuke 7 ; Fushimi, Yasutaka 8 ; Fujioka, Tomoyuki 9 ; Nozaki, Taiki 10 ; Yamada, Akira 11 ; Ito, Rintaro 1 ; Fujima, Noriyuki 12 ; Yanagawa, Masahiro 13 ; Nakaura, Takeshi 14 ; Tsuboyama, Takahiro 15 ; Kamagata, Koji 16 ; Naganawa, Shinji 1 

 Department of Radiology, Nagoya University Graduate School of Medicine , 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550 , Japan 
 Department of Cardiology, Nagoya University Graduate School of Medicine , 65 Tsurumaicho, Showa-ku, Nagoya, Aichi, 466-8550 , Japan 
 Department of Diagnostic Radiology, Hiroshima University , 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 , Japan 
 Department of Diagnostic Imaging , Faculty of Medicine, Hokkaido University , Kita15, Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638 , Japan 
 Department of Radiology, University of Tokyo , 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 , Japan 
 Department of Artificial Intelligence , Graduate School of Medicine, Osaka Metropolitan University , 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585 , Japan 
 Department of Radiology , Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University , 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558 , Japan 
 Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine , 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507 , Japan 
 Department of Diagnostic Radiology, Tokyo Medical and Dental University , 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510 , Japan 
10  Department of Radiology, Keio University School of Medicine , 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 , Japan 
11  Medical Data Science Course, Shinshu University School of Medicine , 3-1-1 Asahi, Matsumoto, Nagano, 390-8621 , Japan 
12  Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital , Kita15, Nishi7, Kita-Ku, Sapporo, Hokkaido, 060-8638 , Japan 
13  Department of Radiology, Osaka University Graduate School of Medicine , 2-2 Yamadaoka, Suita, Osaka, 565-0871 , Japan 
14  Department of Diagnostic Radiology, Kumamoto University Graduate School of Medicine , 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556 , Japan 
15  Department of Radiology, Kobe University Graduate School of Medicine , 7-5-1 Kusunoki-cho,Chuo-ku, Kobe, Hyogo, 650-0017 , Japan 
16  Department of Radiology, Juntendo University Graduate School of Medicine , 2-1-1 Hongo, Bunkyo-ku, Tokyo , Japan 
Pages
1-9
Publication year
2025
Publication date
Jan 2025
Publisher
Oxford University Press
ISSN
04493060
e-ISSN
13499157
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3171188180
Copyright
© The Author(s) 2024. Published by Oxford University Press on behalf of The Japanese Radiation Research Society and Japanese Society for Radiation Oncology. This work is published under https://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.