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Abstract：
Myocardial scar-related ventricular tachycardia is a serious and potentially life-threatening arrhythmia. The prevention of sudden rhythmic death and ventricular tachycardia recurrence relies on implantable cardioverter defibrillator (ICD), anti-arrhythmic drugs and more recently on radiofrequency catheter ablation. Nevertheless, these approaches have their own risk of adverse events and complications, with a recurrence rate up to 50 % at 2 years. Stereotactic body radiotherapy, delivered in a single dose of 25Gy, has emerged as a new therapeutic tool in the management of highly refractory ventricular tachycardia. In 2017, the very first prospective 5-patient cohort suffering from recurrent ventricular tachycardia on structural heart disease (40 % of ischemic cardiomyopathy) who benefited from cardiac stereotactic body radiotherapy was published. After stereotactic body radiotherapy, the authors observed a strong ventricular tachycardia burden reduction at 12 months, with no major side effects. Since then, around 100 cases have been described in the literature, particularly in the prospective ENCORE-VT study, with positive short- and medium-term outcomes in terms of safety and ventricular tachycardia burden reduction. Recently, another American prospective 5-patient series, published in March 2020, mitigated these results since all patients presented a ventricular tachycardia recurrence at 12 months despite an initial reduction in ventricular tachycardia burden. This article describes the use of stereotactic body radiotherapy in refractory VT, the rationale of the technique, its implementation, preliminary results and potential acute and long-term consequences.
摘要：
心肌瘢痕相关的室性心动过速是一种严重且潜在危及生命的心律失常。预防猝死和室性心动过速复发依赖于植入式心律转复除颤器(ICD),抗心律失常药物和最近的射频导管消融。然而，这些方法有其自身的不良事件和并发症的风险，2年复发率高达50%。立体定向身体放射治疗，单剂量25Gy，已成为高度难治性室性心动过速的新治疗工具。2017年，首次发表了因结构性心脏病（缺血性心肌病的40％）而患有复发性室性心动过速的前瞻性5名患者队列，这些患者受益于心脏立体定向身体放射治疗。立体定向身体放疗后，作者观察到12个月时室性心动过速负担明显减少，没有大的副作用.从那以后,文献中已经描述了大约100例，特别是在前瞻性ENCORE-VT研究中，在安全性和室性心动过速负担降低方面，短期和中期结局积极。最近,另一个美国前瞻性5患者系列，在2020年3月发表的研究报告中,尽管室性心动过速负担初步减轻,但所有患者在12个月时都出现室性心动过速复发,从而缓解了这些结果.本文介绍了立体定向放射治疗在难治性VT中的应用，该技术的基本原理，其实施,初步结果和潜在的急性和长期后果。
