An amazing article in the New England Journal of Medicine this week.
This is the preeminent medical journal across the world. They’ve just published the experience of 5 patients who had radiotherapy to treat ventricular tachycardia.
Ventricular tachycardia is a dangerous heart rhythm disturbance that is most frequently caused by electrical short circuits around scar tissue in the heart. The heart can go very fast and not beat efficiently.
Most patients get a defibrillator to prevent sudden death, but this doesn’t prevent the tachycardia from happening – it just deals with the consequences.
Usual treatment is medications – where this fails ablation can be used. This involves putting wires into the heart to deliver microwave energy to burn tissue around the scar that is not working properly but can conduct electricity. This (hopefully) prevents the short circuit in the heart.
Problem is we can get to the muscle on the inside the heart and outside the heart but can’t easily deal with the muscle in-between.
These procedures take 4-8 hours under a general anaesthetic and can be very risky – my last patient we thought had a 20% risk of death from the procedure (he did ok and got home!)
This new method is completely different. An electrical map of the heart is created using an ECG vest and a CT scan that locates the scar. Radiotherapy is delivered around the scar and the procedure takes minutes. It takes time for the cells to react and the procedure to work but these patients had their ventricular tachycardia practically disappear.
Now there are lots of questions to answer about this – larger trials are needed to see if it really does work so well, how long it lasts, if there is collateral damage to the rest of the heart or organs but this is potentially a game changer in the field. You can see why it got published in the top journal. Here’s hoping it develops well and works out because it could transform our care of these patients.