Patient-specific quantification of cardiorespiratory motion for cardiac stereotactic radioablation treatment planning

• Published in: Heart rhythm O2 Vol. 5; no. 4; pp. 234 - 242
• Main Authors: Petzl, Adrian, Benali, Karim, Mbolamena, Nicolas, Dyrda, Katia, Rivard, Léna, Seidl, Sebastian, Martins, Raphaël, Martinek, Martin, Pürerfellner, Helmut, Aguilar, Martin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024; Elsevier
• Subjects: 3D mapping system; Cardiac radioablation; Cardiorespiratory motion; Cardiovascular; Clinical; Stereotactic body radiation therapy; Ventricular tachycardia; Cardiac radioablation; Ventricular tachycardia; 3D mapping system; Stereotactic body radiation therapy; Cardiorespiratory motion
• ISSN: 2666-5018; 2666-5018
• DOI: 10.1016/j.hroo.2024.03.006

Cardiac radioablation is a new treatment for patients with refractory ventricular tachycardia (VT). The target for cardiac radioablation is subject to cardiorespiratory motion (CRM), the heart’s movement with breathing and cardiac contraction. Data regarding the magnitude of target CRM are limited but are highly important for treatment planning. The study sought to assess CRM amplitude by using ablation catheter geometrical data. Electroanatomic mapping data of patients undergoing catheter ablation for VT at 3 academic centers were exported. The spatial position of the ablation catheter as a function of time while in contact with endocardium was analyzed and used to quantify CRM. Forty-four patients with ischemic and nonischemic cardiomyopathy and VT contributed 1364 ablation lesions to the analysis. Average cardiac and respiratory excursion were 1.62 ± 1.21 mm and 12.12 ± 4.10 mm, respectively. The average ratio of respiratory to cardiac motion was approximately 11:1. CRM was greatest along the craniocaudal axis (9.66 ± 4.00 mm). Regional variations with respect to respiratory and cardiac motion were observed: basal segments had smaller displacements vs midventricular and apical segments. Patient characteristics (previous cardiac surgery, height, weight, body mass index, and left ventricular ejection fraction) had a statistically significant, albeit clinically moderate, impact on CRM. CRM is primarily determined by respiratory displacement and is modulated by the location of the target and the patient’s biometric characteristics. The patient-specific quantification of CRM may allow to decrease treatment volume and reduce radiation exposure of surrounding organs at risk while delivering the therapeutic dose to the target.