Stereotactic Arrhythmia Radioablation as a Novel Treatment Approach for Cardiac Arrhythmias: Facts and Limitations
Marina Chalkia,
Vassilis Kouloulias,
Dimitris Tousoulis,
Spyridon Deftereos,
Dimitris Tsiachris,
Dimitrios Vrachatis,
Kalliopi Platoni
Affiliations
Marina Chalkia
Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece
Vassilis Kouloulias
Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece
Dimitris Tousoulis
First Department of Cardiology, ‘Hippokration’ General Hospital, Vasilissis Sofias 114, 115 27 Athens, Greece
Spyridon Deftereos
Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece
Dimitris Tsiachris
Athens Heart Center, Distomou 5-7, 151 25 Athens, Greece
Dimitrios Vrachatis
Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece
Kalliopi Platoni
Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece
Stereotactic ablative radiotherapy (SABR) is highly focused radiation therapy that targets well-demarcated, limited-volume malignant or benign tumors with high accuracy and precision using image guidance. Stereotactic arrhythmia radioablation (STAR) applies SABR to treat cardiac arrhythmias, including ventricular tachycardia (VT) and atrial fibrillation (AF), and has recently been a focus in research. Clinical studies have demonstrated electrophysiologic conduction blockade and histologic fibrosis after STAR, which provides a proof of principle for its potential for treating arrhythmias. This review will present the basic STAR principles, available clinical study outcomes, and how the technique has evolved since the first pre-clinical study. In addition to the clinical workflow, focus will be given on the process for stereotactic radiotherapy Quality Assurance (QA) tests, as well as the need for establishing a standardized QA protocol. Future implications and potential courses of research will also be discussed.
