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- Title
Paroxysmal atrial fibrillation in elderly: Worldwide preliminary data of LINACbased STereotactic Arrhythmia Radioablation prospective phase II trial .
- Authors
Gregucci, Fabiana; Monaco, Antonio Di; Bonaparte, Ilaria; Surgo, Alessia; Troisi, Federica; Ludovico, Elena; Vitulano, Nicola; Quadrini, Federico; Carbonara, Roberta; Ciliberti, Maria Paola; Grimaldi, Massimo; Fiorentino, Alba
- Abstract
Aim: In elderly, paroxysmal Atrial Fibrillation (AF) is difficult to treat with drugs, or by Catheter ablation, so a non-invasive approach should be favourite. No data are published about the use or radiosurgery for AF, thus in the present analysis the preliminary data of Linac-based STereotectic Arrythmias Radioablation (STAR) for elderly affected by paroxysmal AF were reported. Methods: Inclusion criteria were: age >70 years; symptomatic paroxysmal AF; intolerance or nonresponse to anti-arhythmic therapy (AAT). All patients performed 1-week ECG-Holter monitoring, a complete transthoracic echocardiogram before and after STAR. Patients were immobilized using a vac-lock bag and Computed Tomography (CT, 1mm slice-thickness), in the supine position were performed: CT with/without contrast; 4-Dimension CT. STAR was performed in freebreathing with a PTV prescription total dose (Dp) of 25Gy/1 fraction. Flattening Filter Free (FFF), Volumetric Modulated Arc Therapy (VMAT) plan was generated, normalizing 100% Dp to 95% of the volume, while large intra-target dose heterogeneity D2% (PTV)<150%Dp was accepted. The treatment was optimized and delivered by TrueBeamTM (Varian Medical System). Image-guided radiotherapy with Cone Beam CT and Surface-Guided RadioTherapy with Align-RT were used to reduce setup error and to monitor patients during fraction. The primary endpoint is the 1-month post-STAR safety, as complete STAR delivery and no acute treatment-related adverse events more than G3, assessed according to the Common Terminology Criteria for Adverse Events (version 5.0).Results: From May 2021 to January 2022, 5 patients were treated and followed. AAT was stopped after enrollment. For primary endpoint, no acute treatmentrelated adverse events were registered (>G1). Only 1 patient experienced G1 esophagitis (7 days from STAR), improved by 5 days of medical therapy. The treatment plan was delivered with 3 no coplanar arcs, in all cases. The mean Overall Treatment Time (OTT) was 3minutes. For all treated patients with a mean follow-up of 4 months (patients 1-4), no late side effects were reported, and at 3 months, a rare atrial ectopy was documented without AF recurrences. No patients started AAT after radiotherapy Conclusion: The present collected data are promising, showing the safety of LINAC-based STAR for AF for the first 5 patients worldwide. This new ablation approach could represent a valid non-invasive alternative for elderly who were excluded from catheter ablation.
- Subjects
ATRIAL flutter; ATRIAL fibrillation; CONE beam computed tomography; VOLUMETRIC-modulated arc therapy; ARRHYTHMIA; IMAGE-guided radiation therapy
- Publication
Journal of Radiosurgery & SBRT, 2022, Vol 8, p183
- ISSN
2156-4639
- Publication type
Article