Cardiac Stereotactic Body Radiation Therapy for Ventricular Tachycardia: Current Experience and Technical Gaps

2021 ◽  
Author(s):  
Chen Wei ◽  
Pierre C Qian ◽  
Michelle Boeck ◽  
Jeremy S Bredfeldt ◽  
Ron Blankstein ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Ventricular Tachycardia ◽  
Stereotactic Body Radiation Therapy ◽  
Stereotactic Body Radiation ◽  
Current Experience

scholarly journals B-PO02-134 LONG TERM FOLLOW-UP OF STEREOTACTIC BODY RADIATION THERAPY FOR REFRACTORY VENTRICULAR TACHYCARDIA

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S152
Author(s):  
John Austin Wight ◽  
Arielle Schwartz ◽  
Thomas Bigham ◽  
Kristin Higgins ◽  
Michael S. Lloyd
Keyword(s):  
Radiation Therapy ◽  
Ventricular Tachycardia ◽  
Stereotactic Body Radiation Therapy ◽  
Stereotactic Body Radiation ◽  
Long Term Follow Up

scholarly journals Histopathologic and Ultrastructural Findings in Human Myocardium After Stereotactic Body Radiation Therapy for Recalcitrant Ventricular Tachycardia

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Soroosh Kiani ◽  
Leila Kutob ◽  
Frank Schneider ◽  
Kristin A. Higgins ◽  
Michael S. Lloyd
Keyword(s):  
Electron Microscopy ◽  
Radiation Therapy ◽  
Ventricular Tachycardia ◽  
Stereotactic Body Radiation Therapy ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Acute Injury ◽  
Left Ventricular Assist Devices ◽  
Stereotactic Body Radiation ◽  
Histopathologic Features

Background: Stereotactic body radiation therapy (SBRT) is a novel treatment for refractory ventricular tachycardia (VT). While outcomes have been described in small studies, histological findings after SBRT for VT are unknown. Methods: We identified 4 explanted hearts in the context of transplant that received prior SBRT as part of an 11-patient compassionate use series at our institution. Clinical VTs and computed tomography–defined target volume areas of SBRT were correlated to the anatomic specimens. Gross pathological, histological, and ultrastructural examination of tissue in the target area of SBRT was performed. Results: All 4 patients had nonischemic cardiomyopathy, and 3 had left ventricular assist devices. In all cases, patients had recurrent sustained VT and had failed multiple antiarrhythmics and radiofrequency ablations. Four patients underwent 5 total SBRT therapy sessions with 25-Gy single-fraction dose delivered to the area of culprit scar. The time from SBRT to explant ranged from 12 to 250 days. Histopathologic features following radiation were comparable in all patients and were characterized by areas of subendocardial necrosis surrounded by a rim of fibrosis. In 1 patient, the surrounding myocardium showed cytoplasmic vacuolization in myocytes and in another patchy interstitial fibrosis. Vascular changes consisted of myointimal thickening with prominence of endothelial cells. Electron microscopy of myocardium showed irregular, convoluted intercalated disc regions, loss of contractile elements with disrupted and haphazardly arranged myofibrils, and edematous mitochondria with loss of cisternae. Conclusions: Here, we report the first series of findings in human tissue in 4 patients after SBRT. Histopathologic features were consistent across all 4 patients and were indicative of cell injury, death, and to a lesser extent, fibrosis. Electron microscopy demonstrated features consistent with acute injury. These specimens provide radiobiological mechanisms of acute cellular injury during SBRT for VT, which may have an antiarrhythmic effect before the onset of fibrosis.

Sign in / Sign up

Export Citation Format

Share Document