Electroanatomical mapping after cardiac radioablation for treatment of incessant electrical storm

• Verfasst von: Kästner, Lena [VerfasserIn]
• Verfasst von: Boda-Heggemann, Judit [VerfasserIn]
• Verfasst von: Fanslau, Hannah [VerfasserIn]
• Verfasst von: Xie, Jingyang [VerfasserIn]
• Verfasst von: Schweikard, Achim [VerfasserIn]
• Verfasst von: Giordano, Frank Anton [VerfasserIn]
• Verfasst von: Blanck, Oliver [VerfasserIn]
• Verfasst von: Rudic, Boris [VerfasserIn]
• Titel: Electroanatomical mapping after cardiac radioablation for treatment of incessant electrical storm
• Titelzusatz: a case report from the RAVENTA trial
• Verf.angabe: Lena Kaestner, Judit Boda-Heggemann, Hannah Fanslau, Jingyang Xie, Achim Schweikard, Frank A. Giordano, Oliver Blanck, Boris Rudic
• E-Jahr: 2023
• Jahr: 12 September 2023
• Umfang: 7 S.
• Fussnoten: Gesehen am 11.12.2023
• Titel Quelle: Enthalten in: Strahlentherapie und Onkologie
• Ort Quelle: Berlin : Springer Medizin, 1997
• Jahr Quelle: 2023
• Band/Heft Quelle: 199(2023), 11, Seite 1018-1024
• ISSN Quelle: 1439-099X
• DOI: doi:10.1007/s00066-023-02136-z
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1873044526

Abstract

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.