Electroanatomical mapping after cardiac radioablation for treatment of incessant electrical storm: a case report from the RAVENTA trial
Background Electroanatomical mapping (EAM)-guided stereotactic arrhythmia radioablation (STAR) is a novel noninvasive therapy option for patients with monomorphic ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or urgent catheter ablation (CA). Data on success rates in an emergen...
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| Main Authors: | , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
12 September 2023
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| In: |
Strahlentherapie und Onkologie
Year: 2023, Volume: 199, Issue: 11, Pages: 1018-1024 |
| ISSN: | 1439-099X |
| DOI: | 10.1007/s00066-023-02136-z |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1007/s00066-023-02136-z Verlag, kostenfrei, Volltext: https://link.springer.com/10.1007/s00066-023-02136-z 
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| Author Notes: | Lena Kaestner, Judit Boda-Heggemann, Hannah Fanslau, Jingyang Xie, Achim Schweikard, Frank A. Giordano, Oliver Blanck, Boris Rudic |
| Summary: | Background Electroanatomical mapping (EAM)-guided stereotactic arrhythmia radioablation (STAR) is a novel noninvasive therapy option for patients with monomorphic ventricular tachycardia (VT) refractory to antiarrhythmic drugs and/or urgent catheter ablation (CA). Data on success rates in an emergency situation such as electrical storm (ES) are rare. We present a case of a patient with an initially very poor life expectancy after extensive myocardial infarction with therapy-resistant ES, not amendable for further antiarrhythmic drug therapy, implantable cardioverter-defibrillator implantation, or repeated CA who was introduced to the radiation oncology department for emergency STAR as a bail-out therapy. - Methods Target volume definition and transfer from EAM to CT were validated and quality assured with a semi-automatic, dedicated visualization tool (CARDIO-RT). Emergency STAR was performed with 25 Gy in the framework of the RAVENTA study. The VT burden gradually decreased after STAR; however, a second VT morphology occurred, which was successfully treated with EAM-guided CA 12 days after STAR. - Results The second EAM-guided CA showed areas of low voltage in the irradiated segments, indicating a precise targeting and early functional response to STAR. The patient remained free of any VT recurrence or any radiation-related toxicities and in good general condition during the recent follow-up of 18 months. - Conclusion The case highlights the possible approach, caveats, difficulties, and prognosis of a patient severely affected by therapy-resistant VT in whom CA could not lead to VT suppression. Further studies of putative mechanisms of STAR in the acute and chronic phase of this novel therapy are warranted. |
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| Item Description: | Gesehen am 11.12.2023 |
| Physical Description: | Online Resource |
| ISSN: | 1439-099X |
| DOI: | 10.1007/s00066-023-02136-z |