Cardiac SABR vs. catheter ablation for VT in high-risk IHD patients: early experience from a UK centre
D Hunnybun, J Lee, N Kelland, A Kyriacou, G Kirkwood, M A Sammut, P Metherhall, S Riley, M Hatton, S Jamil-CopleyAbstract
Background
Catheter ablation (CA) is a common management strategy for drug-refractory ventricular tachycardia (VT) in patients with ischaemic heart disease (IHD). Patients that fail CA, currently have limited long-term management options. Cardiac stereotactic ablative radiotherapy (cSABR) is an emerging alternative treatment which is gaining interest worldwide.
Purpose
The aim of this study was to provide a real-world comparison of our early experience of cSABR with CA in high-risk patients with IHD at a UK centre.
Methods
All 6 IHD patients treated with cSABR and 22 consecutive high-risk IHD patients treated with CA at a Teaching Hospital between 2015-2024 were identified. Implantable cardioverter defibrillator and patient electronic record data 1-year pre/post treatment was retrospectively reviewed.
Results
Both groups were predominantly male (cSABR 100% vs CA 84%) with similar median age at time of treatment (cSABR 74 vs CA 70 years). All patients had PAINESD scores >16. All patients treated with cSABR had previously undergone unsuccessful, or were unsuitable for, CA. Post-treatment shock-free survival was similar between cSABR and CA groups (median 130 vs 118 days). 4/6 cSABR patients observed a reduction in overall VT burden from 1-year pre- to 1-year post-treatment. Overall survival was similar between groups (median 348 vs 365 days). Median admissions days were higher in the CA group (0 vs 10 days). 1 patient treated with cSABR had CA within the follow up window. 5 patients treated with CA had redo CA within the follow up window. Major acute complications were higher in the CA group (0% vs 13.6%), including cardiogenic shock requiring intra-aortic balloon pump insertion (n=2) and death (n=1).
Conclusion(s)
Our early experience suggests that cSABR offers similar shock-free survival and overall survival to CA with a lower major complication rate. Large, randomised control trials are needed to confirm this finding and inform drug refectory VT management guidelines.Shock-free survival KM curveVT burden 1-yr pre vs 1-yr post cSABR