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Oh S, Liu EH, Trombetta MG, Shaw GC, Thosani AJ, Biederman RW, Mickus TJ, Lee D, Wegner RE, Colonias A, Sohn JW. A target definition based on electroanatomic maps for stereotactic arrhythmia radioablation. Phys Med 2023; 115:103160. [PMID: 37847954 DOI: 10.1016/j.ejmp.2023.103160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
PURPOSE Identifying the target region is critical for successfully treating ventricular tachycardia (VT) with single fraction stereotactic arrhythmia radioablation (STAR). We report the feasibility of target definition based on direct co-registration of electroanatomic maps (EAM) and radioablation planning images. MATERIALS AND METHODS The EAM consists of 3D cardiac anatomy representation with electrical activity at endocardium and is acquired by a cardiac electrophysiologist (CEP) during electrophysiology study. The CEP generates an EAM using a 3D cardiac mapping system anticipating radioablation planning. Our in-house software read these non-DICOM EAMs, registered them to a planning image set, and converted them to DICOM structure files. The EAM based target volume was finalized based on a consensus of CEPs, radiation oncologists and medical physicists, then expanded to ITV and PTV. The simulation, planning, and treatment is performed with a standard STAR technique: a single fraction of 25 Gy using volumetric-modulated arc therapy or dynamic conformal arc therapy depending on the target shape. RESULTS Seven patients with refractory VT were treated by defining the target based on registering EAMs on the planning images. Dice similarity indices between reference map and reference contours after registration were 0.814 ± 0.053 and 0.575 ± 0.199 for LV and LA/RV, respectively. CONCLUSIONS The quality of the transferred EAMs on the MR/CT images was sufficient to localize the treatment region. Five of 7 patients demonstrated a dramatic reduction in VT events after 6 weeks. Longer follow-up is required to determine the true safety and efficacy of this therapy using EAM-based direct registration method.
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Affiliation(s)
- Seungjong Oh
- Division of Radiation Oncology, Cancer Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA; Drexel University College of Medicine: Pittsburgh Campus, Pittsburgh, PA, USA.
| | - Emerson H Liu
- Division of Cardiac Electrophysiology, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Mark G Trombetta
- Division of Radiation Oncology, Cancer Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA; Drexel University College of Medicine: Pittsburgh Campus, Pittsburgh, PA, USA
| | - George C Shaw
- Drexel University College of Medicine: Pittsburgh Campus, Pittsburgh, PA, USA; Division of Cardiac Electrophysiology, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Amit J Thosani
- Division of Cardiac Electrophysiology, Cardiovascular Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert W Biederman
- Division of Cardiology, West Virginia University, Morgantown, WV, USA; Division of Cardiology, Roper/Saint Francis Hospital, Charleston, SC, USA; Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Timothy J Mickus
- Department of Radiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Danny Lee
- Division of Radiation Oncology, Cancer Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA; Drexel University College of Medicine: Pittsburgh Campus, Pittsburgh, PA, USA
| | - Rodney E Wegner
- Division of Radiation Oncology, Cancer Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | - Athanasios Colonias
- Division of Radiation Oncology, Cancer Institute, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA; Drexel University College of Medicine: Pittsburgh Campus, Pittsburgh, PA, USA
| | - Jason W Sohn
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Sung E, Prakosa A, Aronis KN, Zhou S, Zimmerman SL, Tandri H, Nazarian S, Berger RD, Chrispin J, Trayanova NA. Personalized Digital-Heart Technology for Ventricular Tachycardia Ablation Targeting in Hearts With Infiltrating Adiposity. Circ Arrhythm Electrophysiol 2020; 13:e008912. [PMID: 33198484 DOI: 10.1161/circep.120.008912] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Infiltrating adipose tissue (inFAT) is a newly recognized proarrhythmic substrate for postinfarct ventricular tachycardias (VT) identifiable on contrast-enhanced computed tomography. This study presents novel digital-heart technology that incorporates inFAT from contrast-enhanced computed tomography to noninvasively predict VT ablation targets and assesses the capability of the technology by comparing its predictions with VT ablation procedure data from patients with ischemic cardiomyopathy. METHODS Digital-heart models reflecting patient-specific inFAT distributions were reconstructed from contrast-enhanced computed tomography. The digital-heart identification of fat-based ablation targeting (DIFAT) technology evaluated the rapid-pacing-induced VTs in each personalized inFAT-based substrate. DIFAT targets that render the inFAT substrate noninducible to VT, including VTs that arise postablation, were determined. DIFAT predictions were compared with corresponding clinical ablations to assess the capabilities of the technology. RESULTS DIFAT was developed and applied retrospectively to 29 ischemic cardiomyopathy patients with contrast-enhanced computed tomography. DIFAT ablation volumes were significantly less than the estimated clinical ablation volumes (1.87±0.35 versus 7.05±0.88 cm3, P<0.0005). DIFAT targets overlapped with clinical ablations in 79% of patients, mostly in the apex (72%) and inferior/inferolateral (74%). In 3 patients, DIFAT targets colocalized with redo ablations delivered years after the index procedure. CONCLUSIONS DIFAT is a novel digital-heart technology for individualized VT ablation guidance designed to eliminate VT inducibility following initial ablation. DIFAT predictions colocalized well with clinical ablation locations but provided significantly smaller lesions. DIFAT also predicted VTs targeted in redo procedures years later. As DIFAT uses widely accessible computed tomography, its integration into clinical workflows may augment therapeutic precision and reduce redo procedures.
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Affiliation(s)
- Eric Sung
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Adityo Prakosa
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Konstantinos N Aronis
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Shijie Zhou
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - Stefan L Zimmerman
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Department of Radiological Sciences (S.L.Z.), Johns Hopkins Hospital, Baltimore, MD
| | - Harikrishna Tandri
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Saman Nazarian
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia (S.N.)
| | - Ronald D Berger
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Jonathan Chrispin
- Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine (K.N.A., H.T., R.D.B., J.C.), Johns Hopkins Hospital, Baltimore, MD
| | - Natalia A Trayanova
- Department of Biomedical Engineering (E.S., A.P., S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (E.S., A.P., K.N.A., S.Z., S.L.Z., H.T., R.D.B., J.C., N.A.T.), Johns Hopkins University, Baltimore, MD
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3
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Lopez-Perez A, Sebastian R, Izquierdo M, Ruiz R, Bishop M, Ferrero JM. Personalized Cardiac Computational Models: From Clinical Data to Simulation of Infarct-Related Ventricular Tachycardia. Front Physiol 2019; 10:580. [PMID: 31156460 PMCID: PMC6531915 DOI: 10.3389/fphys.2019.00580] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/25/2019] [Indexed: 12/20/2022] Open
Abstract
In the chronic stage of myocardial infarction, a significant number of patients develop life-threatening ventricular tachycardias (VT) due to the arrhythmogenic nature of the remodeled myocardium. Radiofrequency ablation (RFA) is a common procedure to isolate reentry pathways across the infarct scar that are responsible for VT. Unfortunately, this strategy show relatively low success rates; up to 50% of patients experience recurrent VT after the procedure. In the last decade, intensive research in the field of computational cardiac electrophysiology (EP) has demonstrated the ability of three-dimensional (3D) cardiac computational models to perform in-silico EP studies. However, the personalization and modeling of certain key components remain challenging, particularly in the case of the infarct border zone (BZ). In this study, we used a clinical dataset from a patient with a history of infarct-related VT to build an image-based 3D ventricular model aimed at computational simulation of cardiac EP, including detailed patient-specific cardiac anatomy and infarct scar geometry. We modeled the BZ in eight different ways by combining the presence or absence of electrical remodeling with four different levels of image-based patchy fibrosis (0, 10, 20, and 30%). A 3D torso model was also constructed to compute the ECG. Patient-specific sinus activation patterns were simulated and validated against the patient's ECG. Subsequently, the pacing protocol used to induce reentrant VTs in the EP laboratory was reproduced in-silico. The clinical VT was induced with different versions of the model and from different pacing points, thus identifying the slow conducting channel responsible for such VT. Finally, the real patient's ECG recorded during VT episodes was used to validate our simulation results and to assess different strategies to model the BZ. Our study showed that reduced conduction velocities and heterogeneity in action potential duration in the BZ are the main factors in promoting reentrant activity. Either electrical remodeling or fibrosis in a degree of at least 30% in the BZ were required to initiate VT. Moreover, this proof-of-concept study confirms the feasibility of developing 3D computational models for cardiac EP able to reproduce cardiac activation in sinus rhythm and during VT, using exclusively non-invasive clinical data.
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Affiliation(s)
- Alejandro Lopez-Perez
- Center for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Universitat de València, Valencia, Spain
| | - M Izquierdo
- INCLIVA Health Research Institute, Valencia, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Ricardo Ruiz
- INCLIVA Health Research Institute, Valencia, Spain.,Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Martin Bishop
- Division of Imaging Sciences & Biomedical Engineering, Department of Biomedical Engineering, King's College London, London, United Kingdom
| | - Jose M Ferrero
- Center for Research and Innovation in Bioengineering (Ci2B), Universitat Politècnica de València, Valencia, Spain
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4
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Sharp AJ, Mak R, Zei PC. Noninvasive Cardiac Radioablation for Ventricular Arrhythmias. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0596-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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5
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Graeff C, Bert C. Noninvasive cardiac arrhythmia ablation with particle beams. Med Phys 2018; 45:e1024-e1035. [DOI: 10.1002/mp.12595] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/05/2017] [Accepted: 09/17/2017] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christian Graeff
- GSI Helmholzzentrum für Schwerionenforschung GmbH 64291 Darmstadt Germany
| | - Christoph Bert
- Department of Radiation Oncology Universitätsklinikum Erlangen Friedrich‐Alexander‐Universität 91054 Erlangen‐Nürnberg Germany
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Lehmann HI, Deisher AJ, Takami M, Kruse JJ, Song L, Anderson SE, Cusma JT, Parker KD, Johnson SB, Asirvatham SJ, Miller RC, Herman MG, Packer DL. External Arrhythmia Ablation Using Photon Beams. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004304. [DOI: 10.1161/circep.116.004304] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/06/2017] [Indexed: 11/16/2022]
Abstract
Background—
This study sought to investigate external photon beam radiation for catheter-free ablation of the atrioventricular junction in intact pigs.
Methods and Results—
Ten pigs were randomized to either sham irradiation or irradiation of the atrioventricular junction (55, 50, 40, and 25 Gy). Animals underwent baseline electrophysiological evaluation, cardiac gated multi-row computed tomographic imaging for beam delivery planning, and intensity-modulated radiation therapy. Doses to the coronary arteries were optimized. Invasive follow-up was conducted ≤4 months after the irradiation. A mean volume of 2.5±0.5 mL was irradiated with target dose. The mean follow-up length after irradiation was 124.8±30.8 days. Out of 7 irradiated animals, complete atrioventricular block was achieved in 6 animals of all 4 dose groups (86%). Using the same targeting margins, ablation lesion size notably increased with the delivered dose because of volumetric effects of isodose lines around the target volume. The mean macroscopically calculated atrial lesion volume for all 4 dose groups was 3.8±1.1 mL, lesions extended anteriorly into the interventricular septum. No short-term side effects were observed. No damage was observed in the tissues of the esophagus, phrenic nerves, or trachea. However, histology revealed in-field beam effects outside of the target volume.
Conclusions—
Single-fraction doses as low as 25 Gy caused a lesion with interruption of cardiac impulse propagation using this respective target volume. With doses of ≤55 Gy, maximal point-doses to coronary arteries could be kept <7Gy, but target conformity of lesions was not fully achieved using this approach.
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Affiliation(s)
- H. Immo Lehmann
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Amanda J. Deisher
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Mitsuru Takami
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Jon J. Kruse
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Limin Song
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Sarah E. Anderson
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Jack T. Cusma
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Kay D. Parker
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Susan B. Johnson
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Samuel J. Asirvatham
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Robert C. Miller
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Michael G. Herman
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
| | - Douglas L. Packer
- From the Mayo Clinic Translational Interventional Electrophysiology Laboratory (H.I.L., M.T., K.D.P., S.B.J., S.J.A., D.L.P.) and Department of Radiation Oncology (A.J.D., J.J.K., L.S., S.E.A., J.T.C., R.C.M., M.G.H.), Mayo Clinic, Rochester, MN; and Texas Center for Proton Therapy, Irving (L.S.)
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Feasibility Study on Cardiac Arrhythmia Ablation Using High-Energy Heavy Ion Beams. Sci Rep 2016; 6:38895. [PMID: 27996023 PMCID: PMC5171237 DOI: 10.1038/srep38895] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/09/2016] [Indexed: 01/19/2023] Open
Abstract
High-energy ion beams are successfully used in cancer therapy and precisely deliver high doses of ionizing radiation to small deep-seated target volumes. A similar noninvasive treatment modality for cardiac arrhythmias was tested here. This study used high-energy carbon ions for ablation of cardiac tissue in pigs. Doses of 25, 40, and 55 Gy were applied in forced-breath-hold to the atrioventricular junction, left atrial pulmonary vein junction, and freewall left ventricle of intact animals. Procedural success was tracked by (1.) in-beam positron-emission tomography (PET) imaging; (2.) intracardiac voltage mapping with visible lesion on ultrasound; (3.) lesion outcomes in pathohistolgy. High doses (40–55 Gy) caused slowing and interruption of cardiac impulse propagation. Target fibrosis was the main mediator of the ablation effect. In irradiated tissue, apoptosis was present after 3, but not 6 months. Our study shows feasibility to use high-energy ion beams for creation of cardiac lesions that chronically interrupt cardiac conduction.
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8
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Almendral J, Castellanos E. Epicardial ablation in post-myocardial infarction ventricular tachycardia: could it be one of the missing pieces of the puzzle? Circ Arrhythm Electrophysiol 2015; 8:767-8. [PMID: 26286302 DOI: 10.1161/circep.115.003247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jesús Almendral
- From the Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain.
| | - Eduardo Castellanos
- From the Electrophysiology Laboratory and Arrhythmia Unit, Hospital Monteprincipe, Grupo HM Hospitales, University CEU-San Pablo, Madrid, Spain
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9
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Feng XF, Sun J, Wang J, Li YG. Non-response to implantable cardioverter defibrillator in a post-infarction patient with recurrent ventricular tachycardia after catheter ablation. Chin Med J (Engl) 2015; 128:415-6. [PMID: 25635444 PMCID: PMC4837879 DOI: 10.4103/0366-6999.150122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
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