Eva Goethals, Ewoud Vankelecom, Robin De Roover, Kenneth Poels, Cédric Draulans, Eef Dries, Tom Depuydt, Patrick Berkovic, Gabor Voros, Piet Claus, Steven Dymarkowski, Jan Bogaert, Joris Ector, Bert Vandenberk
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引用次数: 0
Abstract
Background: Stereotactic arrhythmia radioablation (STAR) is a novel, non-invasive treatment for therapy-refractory ventricular tachycardia (VT). In STAR, a high dose of radiation is used to non-invasively target and treat the VT substrate. Initial studies indicate promising VT burden reduction, but comprehensive efficacy and safety evaluations remain limited.
Methods: A systematic review (Preferred Reporting Items for Systematic Reviews and Meta-Analyses/Meta-analysis Of Observational Studies in Epidemiology guidelines) included studies on STAR for monomorphic VT identified up to 30 June 2024 via MEDLINE and EMBASE. Outcomes assessed were freedom of VT, percentage reduction in VT episodes and implantable cardioverter-defibrillator (ICD) shocks per month, survival and adverse events (AEs). Meta-analyses included prospective and retrospective studies only, using random-effects models with double arcsine transformation. Subgroup analyses by study design and planning target volume (PTV) were performed. AEs were qualitatively analysed and classified by organ system, severity and causality.
Results: The meta-analysis included 215 patients from 22 studies (age 66.0±4.4 years, 85.9% men, left ventricular ejection fraction 29.8±5.0%, 52.2% ischaemic cardiomyopathy, mean follow-up of 11.9±6.6 months). The overall survival was 69.6% (95% CI 62.6% to 76.2%). VT episodes and ICD shocks/month reduced by 81.5% (95% CI 64.2% to 94.8%) and 84.7% (95% CI 65.1% to 98.1%), respectively. However, only 23.1% (95% CI 10.7% to 37.7%) were VT-free at the end of follow-up. There were no significant differences in clinical outcomes between prospective and retrospective studies, nor between studies with high PTV and low PTV. A total of 352 AEs were reported in 280 patients, with a mean of 1.26 AE per patient. Of these AEs, 50.6% were classified as severe, though only 9.7% were likely STAR-related.
Conclusions: STAR significantly reduces VT episodes and ICD shocks, offering symptomatic relief. However, high recurrence rates and severe AEs underscore the need for protocol optimisation and multidisciplinary collaboration to improve STAR's safety and efficacy in VT management.
背景：立体定向心律失常放射消融术（STAR）是治疗难治性室性心动过速（VT）的一种新型、无创治疗方法。在STAR中，高剂量的辐射用于非侵入性靶向和治疗VT基底。初步研究表明，有希望减少VT负担，但综合疗效和安全性评价仍然有限。方法：一项系统综述（流行病学指南中观察性研究的首选报告项目和荟萃分析/荟萃分析）包括截至2024年6月30日通过MEDLINE和EMBASE确定的STAR治疗单型VT的研究。评估的结果是VT的自由度，每月VT发作和植入式心律转复除颤器（ICD）电击减少的百分比，生存和不良事件（ae）。荟萃分析仅包括前瞻性和回顾性研究，使用双反正弦变换的随机效应模型。通过研究设计和计划目标体积（PTV）进行亚组分析。对ae进行定性分析，并按器官系统、严重程度和因果关系进行分类。结果：荟萃分析纳入22项研究的215例患者（年龄66.0±4.4岁，男性85.9%，左室射血分数29.8±5.0%，缺血性心肌病52.2%，平均随访11.9±6.6个月）。总生存率为69.6% （95% CI 62.6% ~ 76.2%）。VT发作和ICD冲击/月分别减少81.5% （95% CI 64.2% ~ 94.8%）和84.7% （95% CI 65.1% ~ 98.1%）。然而，在随访结束时，只有23.1% （95% CI 10.7%至37.7%）的患者无vt。前瞻性研究和回顾性研究的临床结果无显著差异，高PTV和低PTV研究的临床结果也无显著差异。280例患者共报告352例AE，平均每位患者1.26例AE。在这些ae中，50.6%被归类为严重ae，尽管只有9.7%可能与star相关。结论：STAR显著减少VT发作和ICD休克，提供症状缓解。然而，高复发率和严重的ae强调了方案优化和多学科合作的必要性，以提高STAR在VT管理中的安全性和有效性。
期刊介绍：
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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