Development of a new stereotactic arrhythmia radioablation (STAR) service for ventricular tachycardia (VT) patients in a medium sized radiotherapy department in England

Ventricular arrhythmias (VA) contribute to between 30 – 75% of all sudden cardiac deaths [1] which total around 100,000 per year in the UK, according to the British Heart Foundation. Ventricular tachycarida (VT) is one manifestation of VA and can be caused by cardiomyopathy, structural or ischaemic heart disease, heart failure and some genetic conditions. Its symptoms include dizziness, fainting and chest pain and the condition frequently leads to cardiac arrest and death. Management options include pharmacotherapies (such as beta-blockers, anti-arrhythmia drugs and electrolytes), device therapy including implantable cardioverter defibrillators (ICDs), catheter ablation (normally of cardiac scar tissue) or less frequently, anti-arrythimic surgery [2]. A recent clinical development in this field is to use high energy x-radiation (stereotactic arrhythmia radioablation (STAR) ) in order to ablate scar tissue as an alternative to catheter ablation. This has the advantages of being completely non-invasive and reaching deeper than catheter ablation so having the potential to achieve better control of the condition. This technique is in its infancy: around 100 patients have been treated worldwide. The technology used to plan and deliver the treatments have been Varian and Elekta linear accelerators and Accuray’s CyberKnife system (a robotic radio-surgery platform). To date, 7 STAR deliveries have been in England at 3 centres. This study aims to research and optimise the technological elements of STAR with a view to providing a service in a medium sized radiotherapy centre coupled with an ambitious cardiology unit in the UK. Specifically, the motion of the myocardium and its impact on treatment using C-ARM linear accelerators will be characterised and used to develop treatment techniques optimised for cardiac and respiratory motion.

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