Purpose We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT). Methods Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks. Results Seven out of eight patients (men; age, 70 +/- 7 years; ejection fraction, 27 +/- 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 +/- 33 to 11 +/- 9 (p = .05) and 2 +/- 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients. Conclusion The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy.

Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA-MI-VT phase Ib/II study / C. Carbucicchio, D. Andreini, G. Piperno, V. Catto, E. Conte, F. Cattani, A. Bonomi, E. Rondi, C. Piccolo, S. Vigorito, A. Ferrari, M. Pepa, M. Giuliani, S. Mushtaq, A. Scarà, L. Calò, A. Gorini, F. Veglia, G. Pontone, M. Pepi, E. Tremoli, R. Orecchia, G. Pompilio, C. Tondo, B.A. Jereczek-Fossa. - In: JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY. - ISSN 1383-875X. - 62:2(2021 Nov), pp. 427-439. [10.1007/s10840-021-01060-5]

Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA-MI-VT phase Ib/II study

D. Andreini
Secondo
;
E. Conte;C. Piccolo;S. Vigorito;A. Ferrari;S. Mushtaq;A. Gorini;F. Veglia;G. Pontone;E. Tremoli;R. Orecchia;G. Pompilio;C. Tondo;B.A. Jereczek-Fossa
2021

Abstract

Purpose We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT). Methods Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks. Results Seven out of eight patients (men; age, 70 +/- 7 years; ejection fraction, 27 +/- 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 +/- 33 to 11 +/- 9 (p = .05) and 2 +/- 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients. Conclusion The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy.
Catheter ablation; Multimodal imaging; Stereotactic body radiotherapy/radioablation; Structural heart disease/dilated cardiomyopathy; Ventricular tachycardia/ventricular arrhythmias
Settore MED/11 - Malattie dell'Apparato Cardiovascolare
5-ott-2021
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/872948
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