Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology

Abstract

Purpose. The aim of the experimental study was to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Material and methods. The research was carried out on 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. Linear accelerator «TrueBeam», Varian was used for the experiment. Animals were divided into groups according to the zones of planned radiation exposure: 1st animal AV node (dose 35 Gy), 2nd animal AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal pulmonary veins (PV) and left atrium (dose 30 Gy), 4th AV node and free wall of the LV (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in 3 projections: axial, frontal and sagittal. For electrophysiological control, loop recorders were implanted in each animal. The average exposure time was 11±7 minutes. The long-term follow-up period was 6 months, followed by morphological examination of autopsy material.Results. The average follow-up period after the experiment was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, whose AV-node was exposed: 2nd animal 40 Gy on 108th day of observation and 4th animal 45 Gy on 21st day of observation. No cardiac arrhythmias were recorded in all cases. The results of macroand microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern arrhythmology as an alternative ablation method.