Cardiac stereotactic radiation therapy for refractory ventricular arrhythmias in patients with left ventricular assist devices
Corresponding Author
Karim Benali MD
Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
LTSI-UMR 1099, Rennes, France
Correspondence Karim Benali, MD, Liryc, Electrophysiology and Heart modeling Institute, Bordeaux, F-33400, France.
Email: [email protected] and [email protected]
Search for more papers by this authorMichael S. Lloyd MD
Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorAndranik Petrosyan MD, PhD
Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
Search for more papers by this authorLouis Rigal MD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Search for more papers by this authorMagali Quivrin MD
Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
Search for more papers by this authorIgor Bessieres MD, PhD
Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
Search for more papers by this authorNefissa Hammache MD
Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
Search for more papers by this authorJulien Bellec MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
Search for more papers by this authorAntoine Simon MD, PhD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Search for more papers by this authorGabriel Laurent MD, PhD
Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
Search for more papers by this authorKristin Higgins
Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorFabien Garnier MD
Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
Search for more papers by this authorRenaud de Crevoisier MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
Search for more papers by this authorRaphaël Martins MD, PhD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
Search for more papers by this authorAntoine Da Costa MD, PhD
Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
Search for more papers by this authorCharles Guenancia MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
Search for more papers by this authorCorresponding Author
Karim Benali MD
Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
LTSI-UMR 1099, Rennes, France
Correspondence Karim Benali, MD, Liryc, Electrophysiology and Heart modeling Institute, Bordeaux, F-33400, France.
Email: [email protected] and [email protected]
Search for more papers by this authorMichael S. Lloyd MD
Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
Search for more papers by this authorAndranik Petrosyan MD, PhD
Department of Cardiac Surgery, Saint-Etienne University Hospital Center, Saint-Etienne, France
Search for more papers by this authorLouis Rigal MD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Search for more papers by this authorMagali Quivrin MD
Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
Search for more papers by this authorIgor Bessieres MD, PhD
Department of Radiation Oncology, Centre Georges Francois Leclerc, Dijon, France
Search for more papers by this authorNefissa Hammache MD
Department of Cardiac Electrophysiology, Nancy University Hospital Center, Nancy, France
Search for more papers by this authorJulien Bellec MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
Search for more papers by this authorAntoine Simon MD, PhD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Search for more papers by this authorGabriel Laurent MD, PhD
Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
Search for more papers by this authorKristin Higgins
Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
Search for more papers by this authorFabien Garnier MD
Department of Cardiac Electrophysiology, Dijon University Hospital Center, Dijon, France
Search for more papers by this authorRenaud de Crevoisier MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
Search for more papers by this authorRaphaël Martins MD, PhD
Department of Signal Analysis, IHU LIRYC, Electrophysiology and Heart Modelling Institute, Bordeaux University, Bordeaux, France
Department of Cardiac Electrophysiology, Rennes University Hospital Center, Rennes, France
Search for more papers by this authorAntoine Da Costa MD, PhD
Department of Cardiac Electrophysiology, Saint-Etienne University Hospital Center, Saint-Etienne, France
Search for more papers by this authorCharles Guenancia MD, PhD
Department of Radiation Oncology, Centre Eugene Marquis, Rennes, France
PEC 2 EA 7460, University of Burgundy and Franche-Comté, Dijon, France
Search for more papers by this authorDisclosures: None.
Abstract
Left ventricular assist device (LVAD) implantation is an established treatment for patients with advanced heart failure refractory to medical therapy. However, the incidence of ventricular arrhythmias (VAs) is high in this population, both in the acute and delayed phases after implantation. About one-third of patients implanted with an LVAD will experience sustained VAs, predisposing these patients to worse outcomes and complicating patient management. The combination of pre-existing myocardial substrate and complex electrical remodeling after LVAD implantation account for the high incidence of VAs observed in this population. LVAD patients presenting VAs refractory to antiarrhythmic therapy and catheter ablation procedures are not rare. In such patients, treatment options are extremely limited. Stereotactic body radiation therapy (SBRT) is a technique that delivers precise and high doses of radiation to highly defined targets, reducing exposure to adjacent normal tissue. Cardiac SBRT has recently emerged as a promising alternative with a growing number of case series reporting the effectiveness of the technique in reducing the VA burden in patients with arrhythmias refractory to conventional therapies. The safety profile of cardiac SBRT also appears favorable, even though the current clinical experience remains limited. The use of cardiac SBRT for the treatment of refractory VAs in patients implanted with an LVAD are even more scarce. This review summarizes the clinical experience of cardiac SBRT in LVAD patients and describes technical considerations related to the implementation of the SBRT procedure in the presence of an LVAD.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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