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Published July 7, 2022 | Version v1
Journal article Open

Histopathological Examination of an Explanted Heart in a Long-Term Responder to Cardiac Stereotactic Body Radiotherapy (STereotactic Arrhythmia Radioablation)

  • 1. IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  • 2. Department of Electrocardiology, Upper Silesian Heart Center, Medical University of Silesia, Katowice, Poland
  • 3. Department of Histopathology, Silesian Centre for Heart Diseases, Zabrze, Poland
  • 4. Department of Electrocardiology, Upper Silesian Heart Center, Medical University of Silesia, Katowice, Poland, Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
  • 5. Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland 5Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland 6Department of Electrocardiology, John Paul II Hospital, Kraków, Poland
  • 6. Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland, Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
  • 7. Department of Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  • 8. Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
  • 9. Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  • 10. Department of Cardiac Surgery, Heart and Lung Transplantation, Mechanical Circulatory Support, Silesian Centre for Heart Diseases, Zabrze, Poland, Anaesthesiology and Intensive Care Unit, District Hospital in Oława, Oława, Poland
  • 11. Department of Cardiac Surgery and Transplantology, Silesian Centre for Heart Diseases, Zabrze, Poland
  • 12. Tumor Pathology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
  • 13. Department of Medical Physics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland

Description

Cardiac stereotactic body radiotherapy is an emerging treatment method for recurrent ventricular tachycardia refractory to invasive treatment methods. The single-fraction delivery of 25 Gy was assumed to produce fibrosis, similar to a post-radiofrequency ablation scar. However, the dynamics of clinical response and recent preclinical findings suggest a possible different mechanism. The data on histopathological presentation of post-radiotherapy hearts is scarce, and the authors provide significantly different conclusions. In this article, we present unique data on histopathological examination of a heart explanted from a patient who had a persistent anti-arrhythmic response that lasted almost a year, until a heart failure exacerbation caused a necessity of a heart transplant. Despite a complete treatment response, there was no homogenous transmural fibrosis in the irradiated region, and the overall presentation of the heart was similar to other transplanted hearts of patients with advanced heart failure. In conclusion, our findings support the theorem of functional changes as a source of the anti-arrhythmic mechanism of radiotherapy and show that durable treatment response can be achieved in absence of transmural fibrosis of the irradiated myocardium.

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Additional details

Funding

STOPSTORM – A PROSPECTIVE EUROPEAN VALIDATION COHORT FOR STEREOTACTIC THERAPY OF RE-ENTRANT TACHYCARDIA 945119
European Commission