Question special

Ventricular tachycardia events in patients with structural heart disease are a major source of morbidity and mortality. Therapy with implantable cardioverter defibrillators, while life-saving, can be associated with painful shocks, worsening heart failure and perhaps even worsened mortality. Antiarrhythmic drugs used to control VT episodes have important limiting side effects. Standard catheter ablation approaches have efficacy that is at times limited by large complex substrates producing ventricular arrhythmia, as well as by difficult-to-reach intramural or epicardial VT circuits. The use of cardiac radiation in such patients is quite appealing. Further the noninvasive nature of the therapy is also attractive, given the operative risks that accompany some of these patients.

In an ethical sense going forward with investigations into this technology, what patient population would we be comfortable considering for this approach (i.e. how many prior failed ablations, how large the scar substrate, how acute the arrhythmic burden)?