Stereotactic Arrhythmia Radioablation of Recurrent Ventricular Tachycardia in Structural Heart Disease: Results of the Aborted STAR-VT-2020 Randomized Trial.
Stereotactic radioablation had 4-fold higher risk of repeat ablation for ventricular tachycardia
Stereotactic Arrhythmia Radioablation of Recurrent Ventricular Tachycardia in Structural Heart Disease: Results of the Aborted STAR-VT-2020 Randomized Trial.
Stereotactic arrhythmia radioablation (stereotactic arrhythmia radioablation) has been proposed to treat refractory ventricular tachycardia (ventricular tachycardia) in patients with structural heart disease (structural heart disease).
The aim of the stereotactic arrhythmia radioablation-VT-2020 (Stereotactic Ablative Radiosurgery of Recurrent Ventricular Tachycardia in Structural Heart Disease) randomized trial was to compare the efficacy of stereotactic arrhythmia radioablation and catheter ablation (catheter ablation) after a failure of previous catheter ablation.
With ventricular tachycardia recurrences were randomized at 2 centers (June 2020 to January 2024) to the stereotactic arrhythmia radioablation or catheter ablation group in a 1:1 fashion using a covariate-adaptive algorithm.
Stereotactic arrhythmia radioablation patients needed repeat ablation far more often than catheter ablation
Throughout the trial, 13 patients died, 3 underwent heart transplantation, and 3 received left ventricular assist devices, with no significant differences between the 2 groups.
The stereotactic arrhythmia radioablation-VT-2020 trial suggests a potential clinical benefit of repeated catheter ablation over stereotactic arrhythmia radioablation in patients with structural heart disease, despite prior failed catheter ablation at specialized centers.
Because of the small study cohort of highly selected patients and several methodological limitations, the results of the prematurely terminated trial should be considered exploratory and interpreted strictly as hypothesis generating.
Larger trials with optimized design are warranted.