51
|
Anselmino M, De Ferrari GM. Future Perspectives and New "Frontiers" in Cardiac Rhythmology. Front Cardiovasc Med 2020; 7:126. [PMID: 33005631 PMCID: PMC7479197 DOI: 10.3389/fcvm.2020.00126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022] Open
Abstract
In the last three decades the Cardiac Rhythmology field has experienced tremendous change and evolution. Our understanding of the underlying mechanism of arrhythmic diseases has dramatically improved, starting from the genetic and molecular mechanisms. Innovative pharmacological and non-pharmacological treatment options have been introduced, and arrhythmias previously considered “untreatable” are now successfully managed in most referral centers. The increasing awareness of the detrimental effects of arrhythmias on any underlying cardiac substrate, targeted as a potentially modifiable cause, has therefore led to an increasingly stronger effort in developing novel methods and approaches to treat arrhythmia and improve patients' health and quality of life. Of all potentially significant developments in the field, we have decided to focus on the approaches generally applicable to multiple arrhythmic cardiac disorders and related to the advancement of technology. More specifically, we will deal with electroanatomical mapping and lesion creation during interventional procedures.
Collapse
Affiliation(s)
- Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute e Della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, "Città Della Salute e Della Scienza di Torino" Hospital, University of Turin, Turin, Italy
| |
Collapse
|
53
|
Jumeau R, Ozsahin M, Schwitter J, Elicin O, Reichlin T, Roten L, Andratschke N, Mayinger M, Saguner AM, Steffel J, Blanck O, Vozenin MC, Moeckli R, Zeverino M, Vallet V, Herrera-Siklody C, Pascale P, Bourhis J, Pruvot E. Stereotactic Radiotherapy for the Management of Refractory Ventricular Tachycardia: Promise and Future Directions. Front Cardiovasc Med 2020; 7:108. [PMID: 32671101 PMCID: PMC7329991 DOI: 10.3389/fcvm.2020.00108] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 01/22/2023] Open
Abstract
Ventricular tachycardia (VT) caused by myocardial scaring bears a significant risk of mortality and morbidity. Antiarrhythmic drug therapy (AAD) and catheter ablation remain the cornerstone of VT management, but both treatments have limited efficacy and potential adverse effects. Stereotactic body radiotherapy (SBRT) is routinely used in oncology to treat non-invasively solid tumors with high precision and efficacy. Recently, this technology has been evaluated for the treatment of VT. This review presents the basic underlying principles, proof of concept, and main results of trials and case series that used SBRT for the treatment of VT refractory to AAD and catheter ablation.
Collapse
Affiliation(s)
- Raphael Jumeau
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Multidisciplinary Cancer Care Service, Radiation Oncology Unit, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Juerg Schwitter
- Heart and Vessel Department, Cardiac MR Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland
| | - Michael Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zürich, Switzerland
| | - Jan Steffel
- Department of Cardiology, University Heart Center Zurich, Zürich, Switzerland
| | - Oliver Blanck
- Department of Radiation Oncology and Department of Internal Medicine III, Cardiology, Section for Electrophysiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Marie-Catherine Vozenin
- Radio-Oncology Research Laboratory, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphael Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michele Zeverino
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique Vallet
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claudia Herrera-Siklody
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrizio Pascale
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Etienne Pruvot
- Heart and Vessel Department, Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
54
|
Fiorentino A, Gregucci F, Bonaparte I, Vitulano N, Surgo A, Mazzola R, Di Monaco A, Carbonara R, Alongi F, Langialonga T, Grimaldi M. Stereotactic Ablative radiation therapy (SABR) for cardiac arrhythmia: A new therapeutic option? Radiol Med 2020; 126:155-162. [PMID: 32405924 DOI: 10.1007/s11547-020-01218-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
Abstract
AIM Stereotactic ablative radiation therapy (SABR) is used in non-oncologic indications, recently even for cardiac arrhythmias. Thus, aim of this analysis is to review preclinical, early clinical evidences and future direction of the latter new treatment approach. METHOD A collection of available data regarding SABR and cardiac arrhythmias was made, by Pubmed research and 2 independent researchers, including preclinical and clinical data. A review of ongoing trials was conducted on ClinicalTrials.gov. RESULTS Preclinical research conducted in animal models showed that a safe and effective noninvasive treatment approach for cardiac arrhythmias could be represented by SABR with a median time of response around 2-3 months. The treatment dose plays a crucial role: the atrioventricular node would seem more radiosensitive than the other cardiac electric zones. Clinical data, such as published case series, case reports and early prospective studies, have already suggested the feasibility, efficacy and safety of SABR (25 Gy in one session) for refractory ventricular arrhythmias. CONCLUSION Considering the ongoing trials of SABR and new technological improvements in radiotherapy (e.g. hybrid magnetic resonance) and in arrhythmias noninvasive mapping systems, the future analyses will improve the reliability of those preliminary results.
Collapse
Affiliation(s)
- Alba Fiorentino
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy
| | - Fabiana Gregucci
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy.
| | - Ilaria Bonaparte
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy
| | - Nicola Vitulano
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy
| | - Rosario Mazzola
- Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Antonio Di Monaco
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Roberta Carbonara
- Department of Radiation Oncology, General Regional Hospital "F. Miulli", Strada Prov 127, 70021, Acquaviva delle Fonti, Bari, Italy
| | - Filippo Alongi
- Department of Radiation Oncology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - Tommaso Langialonga
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Massimo Grimaldi
- Department of Cardiology, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| |
Collapse
|