A STAR is born

B. Kirstein (Lübeck)¹, C.-H. Heeger (Hamburg)², M. Grehn (Kiel)³, J. Vogler (Hamburg)⁴, C. Eitel (Lübeck)⁵, S. Ș. Popescu (Lübeck)⁵, O. Blanck (Kiel)³, D. Rades (Lübeck)⁶, R. R. Tilz (Lübeck)^5
1Sana-Kliniken Lübeck GmbH Kardiologie Lübeck, Deutschland; ²Asklepios Klinik Altona Kardiologie und Internistische Intensivmedizin Hamburg, Deutschland; ³Universitätsklinikum Schleswig-Holstein Klinik für Strahlentherapie Kiel, Deutschland; ⁴Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; ⁵Universitätsklinikum Schleswig-Holstein Klinik für Rhythmologie Lübeck, Deutschland; ⁶Universitätsklinikum Schleswig-Holstein Klinik für Strahlentherapie Lübeck, Deutschland

Background: StereoTactic Ventricular Arrhythmia Radioablation (STAR) is a promising therapy option for patients with therapy refractory ventricular arrhythmias.

Methods: A 76-year old male patient with dilated cardiomyopathy (HFrEF 25%, NYHA II-III) and history of multiple endo- and epicardial VT ablations since 2006 presented with syncope due to recurrent VT/fVT episodes and device therapy despite antiarrhytmic treatment with amiodarone. After careful therapy discussion informed consent for a STAR procedure was given.

Results: The clinical target volume (CVT, baso- to mid-lateral left ventricle) encompassed 26 ml and was targeted by 25 Gy. Total STAR procedure time was 21 min. On 1-year follow-up, no VT therapy or hospitalisation occured. The patient was off antiarrhythmics, in stable NYHA class II with LVEF 30%, further NT-proBNP improvement and stable device parameters. After STAR mild residual pneumonitis was noticed in the lingula. Pericarditis was absent. No serious STAR-related complications occurred.

Conclusion: STAR is a fast and effective non invasive treatment option for refractory ventricular arrhythmia with impressive VT burden / therapy reduction. Currently used as a bailout therapy the upcoming data from ongoing RCTs (RAVENTA trial) and the STOPSTORM registry will soon report about safety and long-term therapy success.