For people living with severe and recurring heart rhythm problems, treatment options are often limited and carry high risks.
Now, new research suggests that radiation therapy—a technique usually reserved for cancer treatment—may offer a safer, noninvasive alternative to traditional procedures for patients with a life-threatening heart rhythm disorder called ventricular tachycardia.
Ventricular tachycardia, or VT, is a dangerous condition where the heart beats too fast due to electrical disturbances.
Patients with advanced VT often face a difficult journey: they may depend on high doses of medications with unpleasant side effects, carry implanted defibrillators that deliver powerful shocks when their heart rhythm slips out of control, and endure repeated hospital visits.
When medications and initial procedures fail, doctors typically turn to catheter ablation, an invasive treatment that uses heat or freezing to destroy the small sections of heart tissue causing the abnormal rhythm.
While catheter ablation can be effective, repeat procedures often bring greater risks, especially for medically fragile patients.
Over the past few years, doctors and researchers have been exploring a new option: stereotactic arrhythmia radiation therapy (STAR).
This technique uses highly targeted beams of radiation to damage the scarred areas of the heart that trigger abnormal rhythms. The goal is the same as ablation—restoring a normal heartbeat—but without catheters, anesthesia, or the risks of an invasive operation.
Early studies suggested that STAR could reduce VT episodes and drug use while improving quality of life, but until now, it had not been directly compared with catheter ablation.
The new study, presented at the American Society for Radiation Oncology (ASTRO) Annual Meeting in San Francisco and published in the International Journal of Radiation Oncology • Biology • Physics, provides that comparison.
Researchers at Washington University School of Medicine in St. Louis looked back at the records of 43 patients treated for end-stage VT between 2015 and 2018.
All patients had already failed medication therapy, and most had undergone at least one ablation procedure in the past. They were divided into two groups: 22 received radiation therapy, while 21 underwent repeat catheter ablation.
The results showed that radiation therapy was just as effective as ablation in controlling arrhythmia but carried far fewer immediate risks.
Within the first year, 38% of patients treated with ablation experienced serious side effects that required hospitalization, compared with only 9% of those treated with radiation.
Importantly, four patients in the ablation group died within a month of treatment, including one who did not survive the procedure itself. By contrast, none of the deaths in the radiation group during the three-year follow-up period were attributed to treatment side effects.
“From our study, it looks like radiation might be safer, especially in the early period after treatment,” said lead author Dr. Shannon Jiang, a radiation oncology resident physician at Washington University.
She explained that many of the serious complications following ablation were closely followed by patient deaths, while radiation avoided the need for anesthesia and invasive catheters, making it less risky for very sick patients.
Both approaches were comparable in effectiveness: patients went a median of 8.2 months before experiencing another VT episode after radiation, compared to 9.7 months after ablation.
Median survival appeared to favor radiation (28.2 months versus 12.2 months for ablation), though the difference was not statistically significant due to the small number of patients.
After one year, 73% of radiation patients were still alive compared to 58% of ablation patients; at three years, survival was equal at 45% for both groups.
Dr. Jiang cautioned that the study’s small size and retrospective design limit the conclusions that can be drawn. Larger, more rigorous clinical trials are needed to confirm the findings and identify which patients stand to benefit most from cardiac radiation. The first such international trial, known as RADIATE-VT, is currently underway and expected to provide much-needed clarity.
Even so, the results add weight to growing evidence that radiation therapy could become a valuable treatment option for patients with severe VT, particularly those at high risk from anesthesia or invasive procedures.
Today, only a handful of specialized centers offer STAR, but the hope is that more hospitals will adopt the technique if ongoing trials confirm its safety and effectiveness.
For patients and families facing the challenges of refractory VT, these findings provide a glimmer of hope. Radiation therapy could one day mean fewer invasive procedures, fewer hospitalizations, and a safer path to stabilizing one of the most dangerous heart rhythm disorders.
Source: KSR.
