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Purpose: We present the preliminary results of the STRA-MI-VT Study (NCT04066517), a spontaneous, phase Ib/II study, designed to prospectively test the safety and efficacy of stereotactic body radiotherapy (SBRT) in patientswith advanced cardiac disease and intractable ventricular tachycardia (VT)., Methods: Cardiac computed tomography (CT) integrated by electroanatomical mapping was used for substrate identification and merged with dedicated CT scans for treatment plan preparation. A single 25-Gy radioablation dose was delivered by a LINAC-based volumetric modulated arc therapy technique in a non-invasive matter. The primary safety endpoint was treatment-related adverse effects during acute and long-term follow-up (FU), obtained by regular in-hospital controls and implantable cardioverter defibrillator (ICD) remote monitoring. The primary efficacy endpoint was the reduction at 3 and 6 months of VT episodes and ICD shocks., Results: Seven out of eight patients (men; age, 70 ± 7 years; ejection fraction, 27 ± 11%; 3 ischemic, 4 non-ischemic cardiomyopathies) underwent SBRT. At a median 8-month FU, no treatment-related serious adverse event occurred. Three patients died from non-SBRT-related causes. Four patients completed the 6-month FU: the number of VT decreased from 29 ± 33 to 11 ± 9 (p = .05) and 2 ± 2 (p = .08), at 3 and 6 months, respectively; shocks decreased from 11 to 0 and 2, respectively. At 6 months, all patients. showed a significant reduction of VT episodes and no electrical storm recurrence, with the complete regression of iterative VTs in 2/2 patients., Conclusion: The STRA-MI-VT Study suggests that SBRT can be considered an alternative option for the treatment of VT in patients with structural heart disease and highlights the need for further clinical investigation addressing safety and efficacy., (© 2021. The Author(s).)

Purpose: Currently, cardiac implantable electronic devices allow remote monitoring (RM) based on periodic (Boston Latitude [LAT], Medtronic Carelink [MCL], St. Jude Merlin [SJM]) or daily transmissions (Biotronik Home Monitoring [BHM]). The aim of this study was to compare all the current RM systems in normal practice and investigate the effect of periodicity of RM transmissions on early detection of clinical and device-related events., Methods: Two hundred eleven ICD patients (mean age 69±11 years, 158 males), were remotely followed up for 1 year (61 with BHM, 49 with LAT, 65 with MCL, 36 with SJM). Remote follow-ups were configured quarterly, except for the BHM (daily transmissions)., Results: The event-free rates were 49% with BHM, 57% with LAT, 57% with MCL, and 58 % with SJM (long-rank, p=0.23). BHM generated 304 (interquartile range, 184–342) transmissions per patient in a year, LAT 9 (8–11), MCL 7 (5–10), and SJM 8 (7–14) (p<0.000001). Eighty actionable events occurred at 1 year follow-up, 69 (86%) with RM systems: BHM was associated with a higher cumulative rate of actionable events. At a multivariate analysis, daily transmissions were independently associated with an increased probability of event detection as compared to periodic transmission systems. The chance of event detection is reduced by 20% (p=0.036) for a 1-month increase of the between-transmission interval (27 % for actionable events, p=0.004)., Conclusions: Although all RM systems effectively detected major events, daily transmission was associated with a higher probability of early event detection.

Introduction: Catheter ablation (CA) is an established therapy for atrial fibrillation (AF). The SmartTouch catheter (STc) provides information about catheter tip to tissue contact force (CF). The Surround Flow catheter (SFc) provides a uniform cooling of the tip during ablation. We sought to analyze the impact of STc and SFc on CA of paroxysmal AF in terms of feasibility and acute efficacy., Methods and Results: Sixty-three patients (mean age 57.6 ± 9.8 years, 53 males) with paroxysmal AF underwent pulmonary veins (PVs) antral isolation, by using standard ThermoCool catheter (TCc) in 21, STc in 21, and SFc in 21. Total procedural, fluoroscopy, and radiofrequency (RF) delivery times; percentage of persistently deconnected PVs after 30 min; and percentage of isolated PVs at the end of the procedure were measured. The use of both STc and SFc obtained a reduction of fluoroscopy time (TCc 34 ± 18 min, STc 20 ± 10 min, p < 0.001; SFc 21 ± 13 min, p = 0.02 vs TCc) and RF time (TCc 41 ± 13 min, STc 30 ± 14 min, p = 0.013; SFc 30 ± 9 min, p < 0.01 vs TCc). The use of STc resulted in a reduction of procedural time (TCc 181 ± 53 min, STc 140 ± 53 min, p < 0.001; SFc 170 ± 51 min, p = NS vs TCc). The percentage of isolated PVs was comparable between groups (TCc 96 % vs STc 98 % vs SFc 96 %; p = NS). The percentage of deconnected PVs at 30 min was lower in TCc (89 %) than in STc (95 %) and in SFc (95 %) group (p < 0.05)., Conclusions: Both STc and SFc allowed a simplification of CA of paroxysmal AF. In addition, they reduced early PVs reconnection. Sixty-three patients with paroxysmal AF underwent ablation by standard ThermoCool, SmartTouch, or Surround Flow catheter. Both the SmartTouch and the Surround Flow significantly reduced radiofrequency and fluoroscopy times, as well as pulmonary veins reconnection rate at 30 min. Moreover, the SmartTouch reduced overall duration of the procedure.

Purpose: Radiofrequency catheter ablation (RFCA) of supraventricular tachyarrhythmias carries a small but non-negligible radiation risk. Studies in children already showed the feasibility of using three-dimensional mapping systems as the primary guide for catheter visualization and positioning in these RFCAs. We aim to demonstrate the feasibility and safety of such an approach in young and middle-aged patients., Methods: Fifty patients (age 34 ± 12) with supraventricular tachyarrhythmias underwent electrophysiological study; of these, 47 patients proceeded to RFCA guided by the EnSite NavX(TM) system (23 with atrioventricular nodal reentry tachycardia, 16 with an accessory pathway, six with typical atrial flutter, and two with right atrial tachycardia)., Results: In 38/50 cases (76%), electroanatomical mapping avoided fluoroscopy entirely, including four cases requiring access to the left heart chambers by a retrograde approach. In the remaining 12/50 cases (24%), fluoroscopy use was limited to 122 ± 80 s, with a correspondingly low radiation exposure (dose area product 1.3 ± 1.1 mGy × m(2)). All procedures were acutely successful, with a procedural time of 113 ± 37 minutes, and without incurring in any major complication. Over a mean follow-up of 12 ± 3 months, we observed one recurrence of pre-excitation and one relapse of atrial flutter., Conclusions: Our study shows that non-fluoroscopic RFCA of supraventricular tachyarrhythmias using the EnSite NavX(TM) system is feasible, safe, and effective in a population of relatively young adults. Our experience of a non-fluoroscopic approach in these procedures deserves consideration, particularly in the young or in other patients at higher radiation risk.