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Case Reports
. 2022 Aug 22:9:934686.
doi: 10.3389/fcvm.2022.934686. eCollection 2022.

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

Mario Levis  1 , Veronica Dusi  2 , Massimo Magnano  2 , Marzia Cerrato  1 , Elena Gallio  3 , Alessandro Depaoli  4 , Federico Ferraris  2 , Gaetano Maria De Ferrari  2 , Umberto Ricardi  1 , Matteo Anselmino  2
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Case Reports

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 (VSports注册入口)

Mario Levis et al. Front Cardiovasc Med. .

"V体育ios版" Abstract

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 VSports手机版. 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 V体育安卓版. 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 V体育ios版. 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. .

Keywords: cardiac contractility modulation; case report; radiotherapy; stereotactic body radiation therapy; ventricular tachycardia. VSports最新版本.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

"V体育官网" Figures

Figure 1
Figure 1
Anatomical details reconstructed from the preprocedural cardiac CT scan. Aorta in red, left atrium in yellow, right atrium in purple, and right ventricle in green.
Figure 2
Figure 2
(A) Endocardial electroanatomic substrate map (CARTO3, Biosense Webster, Irvine, CA, USA) obtained from the second VT ablation procedure. The map highlights the area of late potentials (LPs) characterized by a local late activation time (LAT) after paced QRS end, located at the basal inferolateral segment of the left ventricle. Mesodiastolic potentials (MPs) recorded during the clinical VT were located at the same spot of the farthest LPs. (B) Integration of CT imaging with CARTO imaging data (bipolar voltage map). In both (A,B), the white outlined area is the arrhythmogenic target for STAR identified at EAM mapping. (C) LV short axis view of cardiac CT angiographic phase with thinned basal inferolateral myocardium. (D) LV short axis view of late cardiac CT phase with hyperdensity on basal inferior-lateral wall that represents transmural fibrosis.
Figure 3
Figure 3
STAR treatment plan. Treatment plan in axial (A), sagittal (B), and coronal (C) orientation are shown, with dose volume histogram (25 Gy is prescribed on 80% isodose).
See this image and copyright information in PMC

References (V体育官网)

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