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arxiv: 2501.18872 · v2 · pith:EBVUAFCUnew · submitted 2025-01-31 · ⚛️ physics.med-ph

Stereotactic Arrhythmia Radioablation for Refractory Ventricular Tachycardia: A Narrative Review and Exploratory Pooled Analysis of Clinical Outcomes and Toxicity

Pith reviewed 2026-05-23 04:42 UTC · model grok-4.3

classification ⚛️ physics.med-ph
keywords stereotactic arrhythmia radioablationventricular tachycardiapooled analysissalvage therapyclinical outcomestoxicityrefractory VTradioablation
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The pith

Stereotactic arrhythmia radioablation reduces ventricular tachycardia burden by 75 percent at six months with grade 3 or higher acute toxicities in 7 percent of cases.

A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.

The paper reviews and pools outcomes from 86 studies on stereotactic arrhythmia radioablation as a non-invasive salvage option for refractory ventricular tachycardia in patients ineligible for catheter ablation. It reports an average 75 percent drop in VT burden at six months, 16 percent mortality at six months rising to 33 percent at twelve months, and low rates of serious acute side effects. A reader would care because these figures suggest the approach could extend options for a high-mortality condition when standard treatments fail. The analysis flags high variability across studies and urges standardized definitions and longer follow-up. It concludes the therapy shows promise but requires prospective trials to define its role.

Core claim

The paper establishes that STAR functions as a promising salvage therapy for refractory VT, shown through pooled data from preclinical studies, case reports, series, and trials yielding 75 percent average VT burden reduction at six months, 16 percent mortality at six months and 33 percent at twelve months, and 7 percent grade 3+ acute toxicities with heart failure most common, alongside subgroup signals of better results in younger patients, those with non-ischemic cardiomyopathy, and higher LVEF.

What carries the argument

The exploratory pooled analysis that aggregates mortality, VT burden reduction, and toxicity rates across 86 heterogeneous studies to derive summary estimates and subgroup comparisons.

If this is right

  • Mortality reaches one third of treated patients by twelve months after the procedure.
  • Younger age, non-ischemic cardiomyopathy, and preserved left ventricular ejection fraction are associated with more favorable outcomes in the available data.
  • Heart failure accounts for the majority of the observed grade 3 or higher acute toxicities.
  • High statistical heterogeneity in VT reduction measures points to inconsistent study methods that limit direct comparisons.
  • The therapy's acute safety profile supports its use as a non-invasive option when catheter ablation is not feasible.

Where Pith is reading between the lines

These are editorial extensions of the paper, not claims the author makes directly.

  • Standardized dosimetric protocols and outcome definitions would allow future studies to produce more comparable results.
  • Real-world registries tracking patients beyond twelve months could reveal whether the initial VT reduction holds over time.
  • Direct comparisons with other salvage approaches in similar patient populations would clarify where STAR fits in overall VT management.
  • Subgroup patterns suggest targeted trials in patients with higher LVEF and non-ischemic disease could optimize candidate selection.

Load-bearing premise

That studies with very different designs, patient groups, and reporting standards can be combined into reliable average outcomes despite clear differences in how the data were collected.

What would settle it

A randomized trial of STAR versus continued medical management that finds no meaningful VT burden reduction or substantially higher rates of serious toxicities than the 7 percent pooled figure.

Figures

Figures reproduced from arXiv: 2501.18872 by Chih-Wei Chang, Jun Zhou, Justin Roper, Keyur D. Shah, Pretesh Patel, Richard Qiu, Sibo Tian, Xiaofeng Yang, Zhen Tian.

Figure 1
Figure 1. Figure 1: PRISMA Flow Diagram of Study Selection Process. Illustrates the systematic selection process for included studies, detailing the number of records identified, screened, excluded, and ultimately included in this review. Reasons for exclusion are categorized, including unrelated topics, insufficient data, duplicates, and non-English publications. (*4 studies were added after independent citation analysis). M… view at source ↗
Figure 3
Figure 3. Figure 3: Forest plots depicting pooled VT burden reduction at 6 months following stereotactic arrhythmia radioablation (STAR), stratified by key subgroups. Each plot shows individual study estimates with 95% confidence intervals and an overall pooled estimate using a random-effects model. Studies are labeled with their reported VT reduction (%) and ordered chronologically. Subgroup comparisons include: (A–B) treatm… view at source ↗
read the original abstract

Purpose: Stereotactic arrhythmia radioablation (STAR) is a non-invasive salvage therapy for refractory ventricular tachycardia (VT), especially in patients ineligible for catheter ablation. This narrative review and pooled analysis evaluates the safety, efficacy, and technical characteristics of STAR, integrating preclinical studies, case reports, case series, and clinical trials. Methods and Materials: A comprehensive review identified 86 studies published between 2015 and 2025, including 12 preclinical studies, 49 case reports, 18 case series, and 7 clinical trials. Study-level data were extracted for pooled analysis of 6- and 12-month mortality, VT burden reduction, and grade 3+ acute toxicities. Subgroup analyses were performed by delivery modality, age, left ventricular ejection fraction (LVEF), and cardiomyopathy type. Results: Pooled mortality was 16% (95% CI: 11-20%) at 6 months and 33% (95% CI: 27-38%) at 12 months. VT burden reduction at 6 months averaged 75% (95% CI: 73-77%) but showed substantial heterogeneity (I^2 = 98.8%). Grade 3+ acute toxicities occurred in 7% (95% CI: 4-10%), with heart failure being most common. Subgroup analyses suggested better outcomes in younger patients, those with NICM, and those with higher LVEF. Conclusions: STAR is a promising salvage therapy with favorable acute safety and efficacy. Outcome heterogeneity and inconsistent reporting highlight the need for standardized definitions, dosimetric protocols, and longer-term follow-up. Prospective trials and real-world registries are critical for refining STAR's role in VT management.

Editorial analysis

A structured set of objections, weighed in public.

Desk editor's note, referee report, simulated authors' rebuttal, and a circularity audit. Tearing a paper down is the easy half of reading it; the pith above is the substance, this is the friction.

Referee Report

2 major / 2 minor

Summary. The manuscript is a narrative review and exploratory pooled analysis of 86 studies (12 preclinical, 49 case reports, 18 case series, 7 trials) on stereotactic arrhythmia radioablation (STAR) for refractory ventricular tachycardia. It extracts and pools data on 6- and 12-month mortality (16% and 33%), 6-month VT burden reduction (75%, I²=98.8%), and grade 3+ toxicities (7%), with subgroup analyses, concluding that STAR is a promising salvage therapy with favorable acute safety and efficacy, while noting the need for standardization.

Significance. If the pooled estimates hold after methodological correction, this work synthesizes emerging evidence on a non-invasive salvage therapy for a difficult patient population, providing quantitative signals on efficacy and safety that could inform clinical practice and trial design. The broad literature search and subgroup explorations add value, though extreme heterogeneity limits interpretability.

major comments (2)
  1. [Results] Results section: The pooled VT burden reduction of 75% (95% CI 73-77%) at 6 months is reported with I² = 98.8%. In a random-effects meta-analysis, such extreme heterogeneity should produce substantially wider confidence intervals; the narrow CI of only 4 percentage points is incompatible with this level of inconsistency and suggests possible use of a fixed-effect model, underestimation of tau², or selective inclusion, directly undermining the reliability of the central efficacy claim.
  2. [Methods and Materials] Methods and Materials: Pooling clinical outcomes (mortality, VT reduction, toxicities) across preclinical studies, case reports, case series, and trials without sensitivity analyses by study design or quality weighting risks substantial confounding, as these differ markedly in rigor, population, and reporting.
minor comments (2)
  1. [Abstract] Abstract: The abstract reports the 75% VT burden reduction without stating the number of studies or patients contributing to the pooled estimate.
  2. [Conclusions] Conclusions: The statement that STAR has 'favorable acute safety and efficacy' should be more explicitly qualified in light of the reported I²=98.8% and inconsistent reporting across studies.

Simulated Author's Rebuttal

2 responses · 0 unresolved

We thank the referee for their constructive comments on our manuscript. We address each major comment below and agree that revisions are warranted to strengthen the statistical reporting and methodological transparency.

read point-by-point responses
  1. Referee: [Results] Results section: The pooled VT burden reduction of 75% (95% CI 73-77%) at 6 months is reported with I² = 98.8%. In a random-effects meta-analysis, such extreme heterogeneity should produce substantially wider confidence intervals; the narrow CI of only 4 percentage points is incompatible with this level of inconsistency and suggests possible use of a fixed-effect model, underestimation of tau², or selective inclusion, directly undermining the reliability of the central efficacy claim.

    Authors: We acknowledge that the reported confidence interval is inconsistent with the high heterogeneity under a random-effects model. Our analysis was exploratory and intended to provide descriptive signals rather than definitive estimates; however, we agree the presentation requires correction. We will revise the Results section to apply an appropriate heterogeneity adjustment (e.g., Hartung-Knapp), widen the intervals accordingly, and explicitly caution that the pooled VT burden reduction should be interpreted only as a preliminary signal given the extreme I². revision: yes

  2. Referee: [Methods and Materials] Methods and Materials: Pooling clinical outcomes (mortality, VT reduction, toxicities) across preclinical studies, case reports, case series, and trials without sensitivity analyses by study design or quality weighting risks substantial confounding, as these differ markedly in rigor, population, and reporting.

    Authors: We agree that pooling across heterogeneous study designs without stratification by type is a methodological limitation. Although subgroup analyses by clinical factors were performed, sensitivity analyses by study design were not included. We will add these in the revised Methods and Results sections, including analyses restricted to clinical studies (excluding preclinical and case reports) and stratification by study type where feasible. revision: yes

Circularity Check

0 steps flagged

No circularity: direct extraction and pooling of published outcomes

full rationale

The paper is a narrative review plus exploratory pooled analysis that extracts mortality, VT burden reduction, and toxicity rates directly from 86 identified studies (preclinical, case reports, series, trials) and computes weighted averages and heterogeneity statistics. No equations, fitted parameters, predictions, or uniqueness claims are present that reduce by construction to the paper's own inputs or self-citations. The reported I²=98.8% and narrow CI are statistical features of the pooling step itself, not evidence of circular self-definition or load-bearing self-citation. The derivation chain is therefore self-contained against external literature benchmarks.

Axiom & Free-Parameter Ledger

0 free parameters · 2 axioms · 0 invented entities

The central claims depend on the validity of the literature synthesis process and the assumption that pooling is appropriate despite noted inconsistencies; no free parameters or new entities are introduced.

axioms (2)
  • domain assumption Literature search and data extraction methods can identify a representative set of studies on STAR.
    Basis for the review of 86 studies from 2015-2025.
  • standard math Standard meta-analytic techniques for proportions and heterogeneity assessment are valid here.
    Used for pooled mortality, VT reduction, and I^2 calculation.

pith-pipeline@v0.9.0 · 5889 in / 1242 out tokens · 65443 ms · 2026-05-23T04:42:44.797948+00:00 · methodology

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Reference graph

Works this paper leans on

105 extracted references · 105 canonical work pages

  1. [1]

    Ventricular Tachycardia and Sudden Cardiac Death

    Koplan BA, Stevenson WG. Ventricular Tachycardia and Sudden Cardiac Death. Mayo Clinic Proceedings 2009;84:289–97. https://doi.org/10.4065/84.3.289

  2. [2]

    Ventricular arrhythmias and sudden cardiac death

    Harris P , Lysitsas D. Ventricular arrhythmias and sudden cardiac death. BJA Education 2016;16:221 –9. https://doi.org/10.1093/bjaed/mkv056

  3. [3]

    Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy

    Soejima K, Stevenson WG, Sapp JL, Selwyn AP , Couper G, Epstein LM. Endocardial and epicardial radiofrequency ablation of ventricular tachycardia associated with dilated cardiomyopathy. Journal of the American College of Cardiology 2004;43:1834–42. https://doi.org/10.1016/j.jacc.2004.01.029

  4. [4]

    Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy

    Zeppenfeld K. Ventricular Tachycardia Ablation in Nonischemic Cardiomyopathy. JACC: Clinical Electrophysiology 2018;4:1123–40. https://doi.org/10.1016/j.jacep.2018.06.014

  5. [5]

    High -Resolution Mapping of Postinfarction Reentrant Ventricular Tachycardia: Electrophysiological Characterization of the Circuit

    Anter E, Tschabrunn CM, Buxton AE, Josephson ME. High -Resolution Mapping of Postinfarction Reentrant Ventricular Tachycardia: Electrophysiological Characterization of the Circuit. Circulation 2016;134:314 –27. https://doi.org/10.1161/CIRCULATIONAHA.116.021955

  6. [7]

    Trends and disparities in ventricular tachycardia mortality in the United States

    Ibrahim R, Sroubek J, Nakhla S, Lee JZ. Trends and disparities in ventricular tachycardia mortality in the United States. Cardiovasc Electrophysiol 2023;34:465–7. https://doi.org/10.1111/jce.15812

  7. [8]

    Santangeli P , Muser D, Maeda S, Filtz A, Zado ES, Frankel DS, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis of randomized controlled trials. Heart Rhythm 2016;13:1552–9. h...

  8. [9]

    A Comparison of Seven Antiarrhythmic Drugs in Patients with Ventricular Tachyarrhythmias

    Mason JW. A Comparison of Seven Antiarrhythmic Drugs in Patients with Ventricular Tachyarrhythmias. N Engl J Med 1993;329:452–8. https://doi.org/10.1056/NEJM199308123290702. 28

  9. [10]

    Development of the Implantable Cardioverter - Defibrillator

    Maron BJ, Estes NAM, Rowin EJ, Maron MS, Reynolds MR. Development of the Implantable Cardioverter - Defibrillator. Journal of the American College of Cardiology 2023;82:353 –73. https://doi.org/10.1016/j.jacc.2023.04.056

  10. [11]

    Quality of Life and Psychological Status of Patients With Implantable Cardioverter Defibrillators

    Thomas SA, Friedmann E, Kao C -W, Inguito P , Metcalf M, Kelley FJ, et al. Quality of Life and Psychological Status of Patients With Implantable Cardioverter Defibrillators. American Journal of Critical Care 2006;15:389–98. https://doi.org/10.4037/ajcc2006.15.4.389

  11. [12]

    Catheter Ablation for Ventricular Tachycardia

    Stevenson WG, Soejima K. Catheter Ablation for Ventricular Tachycardia. Circulation 2007;115:2750 –60. https://doi.org/10.1161/CIRCULATIONAHA.106.655720

  12. [13]

    Catheter ablation of postinfarction ventricular tachycardia: Ten -year trends in utilization, in -hospital complications, and in - hospital mortality in the United States

    Palaniswamy C, Kolte D, Harikrishnan P , Khera S, Aronow WS, Mujib M, et al. Catheter ablation of postinfarction ventricular tachycardia: Ten -year trends in utilization, in -hospital complications, and in - hospital mortality in the United States. Heart Rhyth m 2014;11:2056 –63. https://doi.org/10.1016/j.hrthm.2014.07.012

  13. [14]

    Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease

    Santangeli P , Frankel DS, Tung R, Vaseghi M, Sauer WH, Tzou WS, et al. Early Mortality After Catheter Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. Journal of the American College of Cardiology 2017;69:2105–15. https://doi.org/10.1016/j.jacc.2017.02.044

  14. [15]

    Stereotactic Radioablation for Treatment of Ventricular Tachycardia

    Jadczyk T, Miszczyk M, Kurzelowski R, Latusek T, Bednarek J, Golba KS, et al. Stereotactic Radioablation for Treatment of Ventricular Tachycardia. In: Jadczyk T, Caluori G, Loewe A, Golba KS, editors. Innovative Treatment Strategies for Clinical Electroph ysiology, Singapore: Springer Nature Singapore; 2022, p. 1 –27. https://doi.org/10.1007/978-981-19-6649-1_1

  15. [16]

    A case of primary cardiac B cell lymphoma associated with ventricular tachycardia, successfully treated with systemic chemotherapy and radiotherapy: a long-term survival case

    Miyashita T, Miyazawa I, Kawaguchi T, Kasai T, Yamaura T, Ito T, et al. A case of primary cardiac B cell lymphoma associated with ventricular tachycardia, successfully treated with systemic chemotherapy and radiotherapy: a long-term survival case. Jpn Circ J 2000;64:135–8. https://doi.org/10.1253/jcj.64.135

  16. [17]

    A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma

    Tanaka Y , Yamabe H, Yamasaki H, Tsuda H, Nagayoshi Y , Kawano H, et al. A case of reversible ventricular tachycardia and complete atrioventricular block associated with primary cardiac B-cell lymphoma. Pacing Clin Electrophysiol 2009;32:816–9. https://doi.org/10.1111/j.1540-8159.2009.02372.x

  17. [19]

    Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia

    Cuculich PS, Schill MR, Kashani R, Mutic S, Lang A, Cooper D, et al. Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia. N Engl J Med 2017;377:2325–36. https://doi.org/10.1056/NEJMoa1613773

  18. [20]

    A Meta-analysis of the Efficacy and Safety of Stereotactic Arrhythmia Radioablation (STAR) in Patients with Refractory Ventricular Tachycardia

    Viani GA, Gouveia AG, Pavoni JF, Louie AV, Detsky J, Spratt DE, et al. A Meta-analysis of the Efficacy and Safety of Stereotactic Arrhythmia Radioablation (STAR) in Patients with Refractory Ventricular Tachycardia. Clin Oncol (R Coll Radiol) 2023;35:611–20. https://doi.org/10.1016/j.clon.2023.04.004. 29

  19. [21]

    One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis

    Benali K, Zei PC, Lloyd M, Kautzner J, Guenancia C, Ninni S, et al. One-year mortality and causes of death after stereotactic radiation therapy for refractory ventricular arrhythmias: A systematic review and pooled analysis. Trends Cardiovasc Med 2024;34:488–96. https://doi.org/10.1016/j.tcm.2023.12.008

  20. [22]

    Stereotactic arrhythmia radioablation (STAR) -A systematic review and meta -analysis of prospective trials on behalf of the STOPSTORM.eu consortium

    Miszczyk M, Hoeksema WF, Kuna K, Blamek S, Cuculich PS, Grehn M, et al. Stereotactic arrhythmia radioablation (STAR) -A systematic review and meta -analysis of prospective trials on behalf of the STOPSTORM.eu consortium. Heart Rhythm 2024:S1547 -5271(24)02912-6. https://doi.org/10.1016/j.hrthm.2024.07.029

  21. [23]

    Stereotactic cardiac radiotherapy for refractory ventricular tachycardia in structural heart disease patients: a systematic review

    Gupta A, Sattar Z, Chaaban N, Ranka S, Carlson C, Sami F, et al. Stereotactic cardiac radiotherapy for refractory ventricular tachycardia in structural heart disease patients: a systematic review. Europace 2024;27. https://doi.org/10.1093/europace/euae305

  22. [24]

    The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

    Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021:n71. https://doi.org/10.1136/bmj.n71

  23. [25]

    Inducibility of Ventricular Arrhythmia 1 Year Following Treatment with Heavy Ion Irradiation in Dogs with Myocardial Infarction

    Amino M, Yoshioka K, Furusawa Y , Tanaka S, Kawabe N, Hashida T, et al. Inducibility of Ventricular Arrhythmia 1 Year Following Treatment with Heavy Ion Irradiation in Dogs with Myocardial Infarction. Pacing Clin Electrophysiol 2017;40:379–90. https://doi.org/10.1111/pace.13031

  24. [26]

    Heavy Ion Irradiation Reduces Vulnerability to Atrial Tachyarrhythmias - Gap Junction and Sympathetic Neural Remodeling

    Amino M, Yamazaki M, Yoshioka K, Kawabe N, Tanaka S, Shimokawa T, et al. Heavy Ion Irradiation Reduces Vulnerability to Atrial Tachyarrhythmias - Gap Junction and Sympathetic Neural Remodeling. Circ J 2023;87:1016–26. https://doi.org/10.1253/circj.CJ-22-0527

  25. [29]

    Safety and efficacy of stereotactic radioablation targeting pulmonary vein tissues in an experimental model

    Zei PC, Wong D, Gardner E, Fogarty T, Maguire P . Safety and efficacy of stereotactic radioablation targeting pulmonary vein tissues in an experimental model. Heart Rhythm 2018;15:1420 –7. https://doi.org/10.1016/j.hrthm.2018.04.015

  26. [30]

    Left ventricular function after noninvasive cardiac ablation using proton beam therapy in a porcine model

    Hohmann S, Deisher AJ, Suzuki A, Konishi H, Rettmann ME, Merrell KW, et al. Left ventricular function after noninvasive cardiac ablation using proton beam therapy in a porcine model. Heart Rhythm 2019;16:1710–9. https://doi.org/10.1016/j.hrthm.2019.04.030

  27. [31]

    Catheter-free ablation of infarct scar through proton beam therapy: Tissue effects in a porcine model

    Hohmann S, Deisher AJ, Konishi H, Rettmann ME, Suzuki A, Merrell KW, et al. Catheter-free ablation of infarct scar through proton beam therapy: Tissue effects in a porcine model. Heart Rhythm 2020;17:2190 –9. https://doi.org/10.1016/j.hrthm.2020.07.011. 30

  28. [32]

    Ventricular arrhythmia inducibility in porcine infarct model after stereotactic body radiation therapy

    Kancharla K, Olson A, Salavatian S, Kuwabara Y , Martynyuk Y , Dutta P , et al. Ventricular arrhythmia inducibility in porcine infarct model after stereotactic body radiation therapy. Heart Rhythm 2024;21:1154 –60. https://doi.org/10.1016/j.hrthm.2024.02.037

  29. [33]

    One-Week Dynamic Changes in Cardiac Proteomes After Cardiac Radioablation in Experimental Rat Model

    Kim BH, Jung JW, Han D, Cha M-J, Chang JH. One-Week Dynamic Changes in Cardiac Proteomes After Cardiac Radioablation in Experimental Rat Model. Front Cardiovasc Med 2022;9:898222. https://doi.org/10.3389/fcvm.2022.898222

  30. [34]

    Electrophysiological and Pathological Impact of Medium-Dose External Carbon Ion and Proton Beam Radiation on the Left Ventricle in an Animal Model

    Takami M, Hara T, Okimoto T, Suga M, Fukuzawa K, Kiuchi K, et al. Electrophysiological and Pathological Impact of Medium-Dose External Carbon Ion and Proton Beam Radiation on the Left Ventricle in an Animal Model. J Am Heart Assoc 2021;10:e019687. https://doi.org/10.1161/JAHA.120.019687

  31. [37]

    Rescue procedure for an electrical storm using robotic non -invasive cardiac radio -ablation

    Jumeau R, Ozsahin M, Schwitter J, Vallet V, Duclos F, Zeverino M, et al. Rescue procedure for an electrical storm using robotic non -invasive cardiac radio -ablation. Radiother Oncol 2018;128:189 –91. https://doi.org/10.1016/j.radonc.2018.04.025

  32. [38]

    Stereotactic radiosurgery as a treatment for recurrent ventricular tachycardia associated with cardiac fibroma

    Haskova J, Peichl P , Pirk J, Cvek J, Neuwirth R, Kautzner J. Stereotactic radiosurgery as a treatment for recurrent ventricular tachycardia associated with cardiac fibroma. HeartRhythm Case Reports 2019;5:44 –7. https://doi.org/10.1016/j.hrcr.2018.10.007

  33. [39]

    Case Report: Repeated Stereotactic Radiotherapy of Recurrent Ventricular Tachycardia: Reasons, Feasibility, and Safety

    Haskova J, Peichl P , Šramko M, Cvek J, Knybel L, Jiravský O, et al. Case Report: Repeated Stereotactic Radiotherapy of Recurrent Ventricular Tachycardia: Reasons, Feasibility, and Safety. Front Cardiovasc Med 2022;9:845382. https://doi.org/10.3389/fcvm.2022.845382

  34. [40]

    Electroanatomical mapping -guided stereotactic radiotherapy for right ventricular tachycardia storm

    Bhaskaran A, Downar E, Chauhan VS, Lindsay P , Nair K, Ha A, et al. Electroanatomical mapping -guided stereotactic radiotherapy for right ventricular tachycardia storm. HeartRhythm Case Rep 2019;5:590 –2. https://doi.org/10.1016/j.hrcr.2019.09.007

  35. [41]

    Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report

    Zeng L-J, Huang L-H, Tan H, Zhang H-C, Mei J, Shi H-F, et al. Stereotactic body radiation therapy for refractory ventricular tachycardia secondary to cardiac lipoma: A case report. Pacing Clin Electrophysiol 2019;42:1276–

  36. [42]

    https://doi.org/10.1111/pace.13731

  37. [43]

    Noninvasive ablation of ventricular tachycardia with stereotactic radiotherapy in a patient with arrhythmogenic right ventricular cardiomyopathy

    Martí-Almor J, Jiménez -López J, Rodríguez de Dios N, Tizón H, Vallés E, Algara M. Noninvasive ablation of ventricular tachycardia with stereotactic radiotherapy in a patient with arrhythmogenic right ventricular cardiomyopathy. Rev Esp Cardiol (Engl Ed) 2020;73:97–9. https://doi.org/10.1016/j.rec.2019.06.004. 31

  38. [44]

    Narducci ML, Cellini F, Placidi L, Boldrini L, Perna F, Bencardino G, et al. Case Report: A Case Report of Stereotactic Ventricular Arrhythmia Radioablation (STAR) on Large Cardiac Target Volume by Highly Personalized Inter - and Intra -fractional Image Gu idance. Front Cardiovasc Med 2020;7:565471. https://doi.org/10.3389/fcvm.2020.565471

  39. [45]

    First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia

    Mayinger M, Kovacs B, Tanadini -Lang S, Ehrbar S, Wilke L, Chamberlain M, et al. First magnetic resonance imaging-guided cardiac radioablation of sustained ventricular tachycardia. Radiother Oncol 2020;152:203–7. https://doi.org/10.1016/j.radonc.2020.01.008

  40. [46]

    Stereotactic body radiotherapy for ventricular tachycardia (cardiac radiosurgery) : First -in-patient treatment in Germany

    Krug D, Blanck O, Demming T, Dottermusch M, Koch K, Hirt M, et al. Stereotactic body radiotherapy for ventricular tachycardia (cardiac radiosurgery) : First -in-patient treatment in Germany. Strahlenther Onkol 2020;196:23–30. https://doi.org/10.1007/s00066-019-01530-w

  41. [47]

    Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report

    Park JS, Choi Y . Stereotactic Cardiac Radiation to Control Ventricular Tachycardia and Fibrillation Storm in a Patient with Apical Hypertrophic Cardiomyopathy at Burnout Stage: Case Report. J Korean Med Sci 2020;35:e200. https://doi.org/10.3346/jkms.2020.35.e200

  42. [48]

    First -in-man case of non -invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure

    Dusi V, Vitolo V, Frigerio L, Totaro R, Valentini A, Barcellini A, et al. First -in-man case of non -invasive proton radiotherapy for the treatment of refractory ventricular tachycardia in advanced heart failure. Eur J Heart Fail 2021;23:195–6. https://doi.org/10.1002/ejhf.2056

  43. [49]

    A case report of successful elimination of recurrent ventricular tachycardia by repeated stereotactic radiotherapy: the importance of accurate target volume delineation

    Peichl P , Sramko M, Cvek J, Kautzner J. A case report of successful elimination of recurrent ventricular tachycardia by repeated stereotactic radiotherapy: the importance of accurate target volume delineation. Eur Heart J Case Rep 2021;5:ytaa516. https://doi.org/10.1093/ehjcr/ytaa516

  44. [50]

    Amino M, Kabuki S, Kunieda E, Yagishita A, Ikari Y , Yoshioka K. Analysis of depolarization abnormality and autonomic nerve function after stereotactic body radiation therapy for ventricular tachycardia in a patient with old myocardial infarction. HeartRh ythm Case Rep 2021;7:306 –11. https://doi.org/10.1016/j.hrcr.2021.01.023

  45. [51]

    Immediate Response to Electroanatomical Mapping-Guided Stereotactic Ablative Radiotherapy for Ventricular Tachycardia

    Quick S, Christoph M, Polster D, Ibrahim K, Schöpe M, Klautke G. Immediate Response to Electroanatomical Mapping-Guided Stereotactic Ablative Radiotherapy for Ventricular Tachycardia. Radiat Res 2021;195:596–9. https://doi.org/10.1667/RADE-21-00011.1

  46. [52]

    Incessant ventricular tachycardia treated with cardiac radioablation in an 11 -year-old boy with dilated cardiomyopathy

    Lee Y , Yoon HI, Kim J-S, Kim A-Y , Tsevendee S, Uhm J-S. Incessant ventricular tachycardia treated with cardiac radioablation in an 11 -year-old boy with dilated cardiomyopathy. HeartRhythm Case Rep 2021;7:186 –90. https://doi.org/10.1016/j.hrcr.2020.12.009

  47. [53]

    Radiation -Induced Changes in Ventricular Myocardium After Stereotactic Body Radiotherapy for Recurrent Ventricular Tachycardia

    Kautzner J, Jedlickova K, Sramko M, Peichl P , Cvek J, Ing LK, et al. Radiation -Induced Changes in Ventricular Myocardium After Stereotactic Body Radiotherapy for Recurrent Ventricular Tachycardia. JACC Clin Electrophysiol 2021;7:1487–92. https://doi.org/10.1016/j.jacep.2021.07.012

  48. [54]

    Stereotactic arrhythmia radioablation for intramural basal septal ventricular tachycardia originating near the His bundle

    Thosani A, Trombetta M, Shaw G, Oh S, Sohn J, Liu E. Stereotactic arrhythmia radioablation for intramural basal septal ventricular tachycardia originating near the His bundle. HeartRhythm Case Rep 2021;7:246 –50. https://doi.org/10.1016/j.hrcr.2021.01.012. 32

  49. [55]

    Use of Stereotactic Radioablation Therapy as a Bailout Therapy for Refractory Ventricular Tachycardia in a Patient with a No-entry Left Ventricle

    Aras D, Ozturk HF, Ozdemir E, Kervan U, Kara M, Cay S, et al. Use of Stereotactic Radioablation Therapy as a Bailout Therapy for Refractory Ventricular Tachycardia in a Patient with a No-entry Left Ventricle. J Innov Card Rhythm Manag 2021;12:4671–5. https://doi.org/10.19102/icrm.2021.120902

  50. [56]

    Stereotactic arrhythmia radiotherapy: a case study of real -time image-guided noninvasive treatment for ventricular tachycardia

    Li J, Chen Q, Li G, Li Y , Zhang Y , Li C, et al. Stereotactic arrhythmia radiotherapy: a case study of real -time image-guided noninvasive treatment for ventricular tachycardia. Quant Imaging Med Surg 2022;12:2607–15. https://doi.org/10.21037/qims-21-1025

  51. [57]

    Surgical ablation after stereotactic body radiation therapy for ventricular arrhythmias

    Hayase J, Chin R, Kwon M, Cao M, Hu P , Ajijola O, et al. Surgical ablation after stereotactic body radiation therapy for ventricular arrhythmias. HeartRhythm Case Rep 2022;8:73 –6. https://doi.org/10.1016/j.hrcr.2021.10.006

  52. [58]

    Levis M, Dusi V, Magnano M, Cerrato M, Gallio E, Depaoli A, et al. 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. Front Cardiovasc Med 2022;9:934686. https://doi.org/10.3389/fcvm.2022.934686

  53. [59]

    Case report: Stereotactic body radiation therapy with 12 Gy for silencing refractory ventricular tachycardia

    Huang S-H, Wu Y-W, Shueng P-W, Wang S-Y , Tsai M-C, Liu Y-H, et al. Case report: Stereotactic body radiation therapy with 12 Gy for silencing refractory ventricular tachycardia. Front Cardiovasc Med 2022;9:973105. https://doi.org/10.3389/fcvm.2022.973105

  54. [60]

    Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy -Refractory Ventricular Tachycardia Storm

    van der Ree MH, Dieleman EMT, Visser J, Adam JA, de Bruin -Bon RHA, de Jong RMAJ, et al. Direct Clinical Effects of Cardiac Radioablation in the Treatment of a Patient With Therapy -Refractory Ventricular Tachycardia Storm. Adv Radiat Oncol 2022;7:100992. https://doi.org/10.1016/j.adro.2022.100992

  55. [61]

    Elimination of refractory ventricular tachycardia storm and fibrillation using stereotactic radiotherapy

    Wutzler A, Tiedke B, Osman M, Mahrous N, Wurm R. Elimination of refractory ventricular tachycardia storm and fibrillation using stereotactic radiotherapy. Clin Case Rep 2023;11:e6690. https://doi.org/10.1002/ccr3.6690

  56. [62]

    Noninvasive Stereotactic Radiation for Refractory Ventricular Tachycardia After Failure of Cardiac Sympathetic Denervation

    Bernstein HM, Leon W, Daly ME, Park P , Ghasemiesfe A, Beri N, et al. Noninvasive Stereotactic Radiation for Refractory Ventricular Tachycardia After Failure of Cardiac Sympathetic Denervation. JACC Case Rep 2022;4:1189–94. https://doi.org/10.1016/j.jaccas.2022.06.025

  57. [63]

    Radiosurgery in Treatment of Ventricular Tachycardia - Initial Experience Within the Polish SMART -VT Trial

    Kurzelowski R, Latusek T, Miszczyk M, Jadczyk T, Bednarek J, Sajdok M, et al. Radiosurgery in Treatment of Ventricular Tachycardia - Initial Experience Within the Polish SMART -VT Trial. Front Cardiovasc Med 2022;9:874661. https://doi.org/10.3389/fcvm.2022.874661

  58. [64]

    Stereotactic arrhythmia radioablation in recurrent ventricular tachyarrhythmias

    Cybulska M, Sajdok M, Bednarek J, Miszczyk M, Jadczyk T, Kurzelowski R, et al. Stereotactic arrhythmia radioablation in recurrent ventricular tachyarrhythmias. Kardiol Pol 2022;80:367 –9. https://doi.org/10.33963/KP .a2022.0019

  59. [65]

    Stereotactic radioablation to treat ventricular tachycardia related to a left ventricular mass

    Ninni S, Longere B, Mirabel X. Stereotactic radioablation to treat ventricular tachycardia related to a left ventricular mass. Eur Heart J 2022;43:2341. https://doi.org/10.1093/eurheartj/ehac218. 33

  60. [66]

    Successful Application of Stereotactic Body Radiation Therapy for Ventricular Tachycardia Substrate in a Patient With Nonischemic Cardiomyopathy

    Nasu T, Toba M, Nekomiya N, Itasaka R, Mafune S, Nakata T, et al. Successful Application of Stereotactic Body Radiation Therapy for Ventricular Tachycardia Substrate in a Patient With Nonischemic Cardiomyopathy. Am J Cardiol 2022;184:149–53. https://doi.org/10.1016/j.amjcard.2022.08.017

  61. [67]

    Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report

    Pavone C, Scacciavillani R, Narducci ML, Cellini F, Pelargonio G, Bencardino G, et al. Successful ventricular tachycardia radioablation in a patient with previous chemical pleurodesis: A case report. Front Cardiovasc Med 2022;9:937090. https://doi.org/10.3389/fcvm.2022.937090

  62. [68]

    The Use of Cardiac Stereotactic Radiation Therapy (SBRT) to Manage Ventricular Tachycardia: A Case Report, Review of the Literature and Technical Notes

    Cozzi S, Bottoni N, Botti A, Trojani V, Alì E, Finocchi Ghersi S, et al. The Use of Cardiac Stereotactic Radiation Therapy (SBRT) to Manage Ventricular Tachycardia: A Case Report, Review of the Literature and Technical Notes. J Pers Med 2022;12. https://doi.org/10.3390/jpm12111783

  63. [69]

    Cardiac radioablation of incessant ventricular tachycardia in patients with terminal heart failure under permanent left ventricular assist device therapy-description of two cases

    Mehrhof F, Bergengruen P , Gerds-Li J-H, Jahn A, Kluge AK, Parwani A, et al. Cardiac radioablation of incessant ventricular tachycardia in patients with terminal heart failure under permanent left ventricular assist device therapy-description of two cases. Strahlenther Onkol 2023;199:511–9. https://doi.org/10.1007/s00066-023- 02045-1

  64. [70]

    Cardiac stereotactic radiotherapy for refractory ventricular tachycardia in a patient with wireless left ventricular endocardial stimulation system

    Jiwani S, Akhavan D, Reddy M, Noheria A. Cardiac stereotactic radiotherapy for refractory ventricular tachycardia in a patient with wireless left ventricular endocardial stimulation system. HeartRhythm Case Rep 2023;9:818–22. https://doi.org/10.1016/j.hrcr.2023.08.013

  65. [71]

    van der Ree MH, Herrera Siklody C, Le Bloa M, Pascale P , Porretta AP , Teres CC, et al. Case report: First -in- human combined low-dose whole-heart irradiation and high-dose stereotactic arrhythmia radioablation for immunosuppressive refractory cardiac sarc oidosis and ventricular tachycardia. Front Cardiovasc Med 2023;10:1213165. https://doi.org/10.3389...

  66. [72]

    Electroanatomical mapping after cardiac radioablation for treatment of incessant electrical storm: a case report from the RAVENTA trial

    Kaestner L, Boda-Heggemann J, Fanslau H, Xie J, Schweikard A, Giordano FA, et al. Electroanatomical mapping after cardiac radioablation for treatment of incessant electrical storm: a case report from the RAVENTA trial. Strahlenther Onkol 2023;199:1018–24. https://doi.org/10.1007/s00066-023-02136-z

  67. [73]

    Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia

    Wijesuriya N, Galante JR, Sisodia C, Whitaker J, Ahmad S, Rinaldi CA. Increase in right ventricular lead pacing threshold following stereotactic ablative therapy for ventricular tachycardia. HeartRhythm Case Rep 2023;9:555–9. https://doi.org/10.1016/j.hrcr.2023.05.011

  68. [74]

    Long-Term Results of the First Clinical Application of Stereotactic Radioablation Using a Linear Electron Accelerator for the Treatment of Ventricular Tachycardia

    Vaskovskii VA, Taimasova IA, Artyukhina EA, Antipina NA, Golanov AV, Usachev DY , et al. Long-Term Results of the First Clinical Application of Stereotactic Radioablation Using a Linear Electron Accelerator for the Treatment of Ventricular Tachycardia. Bull Exp Biol Med 2023;174:594–600. https://doi.org/10.1007/s10517- 023-05753-x

  69. [75]

    Successful Noninvasive 12-Lead ECG Mapping-Guided Radiotherapy of Inaccessible Ventricular Tachycardia Substrate Due to Mechanical Valves

    Keyt LK, Atwood T, Bruggeman A, Mundt AJ, Feld GK, Krummen DE, et al. Successful Noninvasive 12-Lead ECG Mapping-Guided Radiotherapy of Inaccessible Ventricular Tachycardia Substrate Due to Mechanical Valves. JACC Case Rep 2023;15:101870. https://doi.org/10.1016/j.jaccas.2023.101870. 34

  70. [76]

    Case of Successful Sympathetic Nerve Modulation by Targeted Heavy Ion Radiotherapy for Idiopathic Ventricular Tachycardia

    Amino M, Wakatsuki M, Mori S, Shimokawa T, Kabuki S, Kunieda E, et al. Case of Successful Sympathetic Nerve Modulation by Targeted Heavy Ion Radiotherapy for Idiopathic Ventricular Tachycardia. Ann Noninvasive Electrocardiol 2024;29:e70020. https://doi.org/10.1111/anec.70020

  71. [77]

    Hypertrophic obstructive cardiomyopathy with recurrent ventricular tachycardias: from catheter ablation and stereotactic radiotherapy to heart transplant -a case report

    Kautzner J, Hašková J, Cvek J, Adamíra M, Peichl P . Hypertrophic obstructive cardiomyopathy with recurrent ventricular tachycardias: from catheter ablation and stereotactic radiotherapy to heart transplant -a case report. Eur Heart J Case Rep 2024;8:ytae379. https://doi.org/10.1093/ehjcr/ytae379

  72. [78]

    3D-targeted, electrocardiographic imaging-aided stereotactic radioablation for ventricular tachycardia storm: a case report

    Kaya YS, Stoks J, Hazelaar C, van Elmpt W, Gommers S, Volders PGA, et al. 3D-targeted, electrocardiographic imaging-aided stereotactic radioablation for ventricular tachycardia storm: a case report. Eur Heart J Case Rep 2024;8:ytae541. https://doi.org/10.1093/ehjcr/ytae541

  73. [79]

    Palliative Stereotactic Body Radiation Therapy for the Treatment of Refractory Ventricular Tachycardia

    Trinh K, Kou A. Palliative Stereotactic Body Radiation Therapy for the Treatment of Refractory Ventricular Tachycardia. Cureus 2025. https://doi.org/10.7759/cureus.80001

  74. [80]

    Phase I/II Trial of Electrophysiology- Guided Noninvasive Cardiac Radioablation for Ventricular Tachycardia

    Robinson CG, Samson PP , Moore KMS, Hugo GD, Knutson N, Mutic S, et al. Phase I/II Trial of Electrophysiology- Guided Noninvasive Cardiac Radioablation for Ventricular Tachycardia. Circulation 2019;139:313 –21. https://doi.org/10.1161/CIRCULATIONAHA.118.038261

  75. [81]

    Non -invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience

    Chin R, Hayase J, Hu P , Cao M, Deng J, Ajijola O, et al. Non -invasive stereotactic body radiation therapy for refractory ventricular arrhythmias: an institutional experience. J Interv Card Electrophysiol 2021;61:535–43. https://doi.org/10.1007/s10840-020-00849-0

  76. [82]

    Stereotactic arrhythmia radioablation for refractory scar -related ventricular tachycardia

    Gianni C, Rivera D, Burkhardt JD, Pollard B, Gardner E, Maguire P , et al. Stereotactic arrhythmia radioablation for refractory scar -related ventricular tachycardia. Heart Rhythm 2020;17:1241 –8. https://doi.org/10.1016/j.hrthm.2020.02.036

  77. [83]

    Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience

    Lee J, Bates M, Shepherd E, Riley S, Henshaw M, Metherall P , et al. Cardiac stereotactic ablative radiotherapy for control of refractory ventricular tachycardia: initial UK multicentre experience. Open Heart 2021;8. https://doi.org/10.1136/openhrt-2021-001770

  78. [84]

    Case series on stereotactic body radiation therapy in non-ischemic cardiomyopathy patients with recurrent ventricular tachycardia

    Yugo D, Lo L-W, Wu Y-H, Chung F-P , Lin Y-J, Chang S-L, et al. Case series on stereotactic body radiation therapy in non-ischemic cardiomyopathy patients with recurrent ventricular tachycardia. Pacing Clin Electrophysiol 2021;44:1085–93. https://doi.org/10.1111/pace.14254

  79. [85]

    Computational ECG mapping and respiratory gating to optimize stereotactic ablative radiotherapy workflow for refractory ventricular tachycardia

    Ho G, Atwood TF, Bruggeman AR, Moore KL, McVeigh E, Villongco CT, et al. Computational ECG mapping and respiratory gating to optimize stereotactic ablative radiotherapy workflow for refractory ventricular tachycardia. Heart Rhythm O2 2021;2:511–20. https://doi.org/10.1016/j.hroo.2021.09.001

  80. [86]

    Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA -MI-VT phase Ib/II study

    Carbucicchio C, Andreini D, Piperno G, Catto V, Conte E, Cattani F, et al. Stereotactic radioablation for the treatment of ventricular tachycardia: preliminary data and insights from the STRA -MI-VT phase Ib/II study. J Interv Card Electrophysiol 2021;62:427–39. https://doi.org/10.1007/s10840-021-01060-5

Showing first 80 references.