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A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis

INTRODUCTION: Catheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhyth...

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Autores principales: Levis, Mario, Dusi, Veronica, Magnano, Massimo, Cerrato, Marzia, Gallio, Elena, Depaoli, Alessandro, Ferraris, Federico, De Ferrari, Gaetano Maria, Ricardi, Umberto, Anselmino, Matteo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441661/
https://www.ncbi.nlm.nih.gov/pubmed/36072883
http://dx.doi.org/10.3389/fcvm.2022.934686
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author Levis, Mario
Dusi, Veronica
Magnano, Massimo
Cerrato, Marzia
Gallio, Elena
Depaoli, Alessandro
Ferraris, Federico
De Ferrari, Gaetano Maria
Ricardi, Umberto
Anselmino, Matteo
author_facet Levis, Mario
Dusi, Veronica
Magnano, Massimo
Cerrato, Marzia
Gallio, Elena
Depaoli, Alessandro
Ferraris, Federico
De Ferrari, Gaetano Maria
Ricardi, Umberto
Anselmino, Matteo
author_sort Levis, Mario
collection PubMed
description INTRODUCTION: Catheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation. CASE PRESENTATION: We hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis. CONCLUSION: Our case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile.
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spelling pubmed-94416612022-09-06 A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis Levis, Mario Dusi, Veronica Magnano, Massimo Cerrato, Marzia Gallio, Elena Depaoli, Alessandro Ferraris, Federico De Ferrari, Gaetano Maria Ricardi, Umberto Anselmino, Matteo Front Cardiovasc Med Cardiovascular Medicine INTRODUCTION: Catheter ablation (CA) is the current standard of care for patients suffering drug-refractory monomorphic ventricular tachycardias (MMVTs). Yet, despite significant technological improvements, recurrences remain common, leading to increased morbidity and mortality. Stereotactic arrhythmia radioablation (STAR) is increasingly being adopted to overcome the limitations of conventional CA, but its safety and efficacy are still under evaluation. CASE PRESENTATION: We hereby present the case of a 73-year-old patient implanted with a mitral valve prosthesis, a cardiac resynchronization therapy-defibrillator, and a cardiac contractility modulation device, who was successfully treated with STAR for recurrent drug and CA-resistant MMVT in the setting of advanced heart failure and a giant left atrium. We report a 2-year follow-up and a detailed dosimetric analysis. CONCLUSION: Our case report supports the early as well as the long-term efficacy of 25 Gy single-session STAR. Despite the concomitant severe heart failure, with an overall heart minus planned target volume mean dosage below 5 Gy, no major detrimental cardiac side effects were detected. To the best of our knowledge, our dosimetric analysis is the most accurate reported so far in the setting of STAR, particularly for what concerns cardiac substructures and coronary arteries. A shared dosimetric planning among centers performing STAR will be crucial in the next future to fully disclose its safety profile. Frontiers Media S.A. 2022-08-22 /pmc/articles/PMC9441661/ /pubmed/36072883 http://dx.doi.org/10.3389/fcvm.2022.934686 Text en Copyright © 2022 Levis, Dusi, Magnano, Cerrato, Gallio, Depaoli, Ferraris, De Ferrari, Ricardi and Anselmino. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Levis, Mario
Dusi, Veronica
Magnano, Massimo
Cerrato, Marzia
Gallio, Elena
Depaoli, Alessandro
Ferraris, Federico
De Ferrari, Gaetano Maria
Ricardi, Umberto
Anselmino, Matteo
A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title_full A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title_fullStr A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title_full_unstemmed A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title_short A case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
title_sort case report of long-term successful stereotactic arrhythmia radioablation in a cardiac contractility modulation device carrier with giant left atrium, including a detailed dosimetric analysis
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9441661/
https://www.ncbi.nlm.nih.gov/pubmed/36072883
http://dx.doi.org/10.3389/fcvm.2022.934686
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