Phá hủy bằng tia xạ không xâm lấn cho các rối loạn nhịp thất

Current Cardiovascular Risk Reports - 2019
Alexander J. Sharp1, Raymond Mak2, Paul C. Zei3
1Addenbrooke’s Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
2Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Dana-Farber Cancer Institute, Boston, USA
3Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA

Tóm tắt

Trong bài tổng quan này, chúng tôi mô tả các nguyên tắc chung và ứng dụng lâm sàng của sự phá hủy bằng tia xạ định vị (SR) và ứng dụng cụ thể của nó trong điều trị các rối loạn nhịp tim thất ác tính, hoặc phá hủy nhịp tim định vị (STAR). Các nguyên tắc của STAR và nhu cầu chưa được đáp ứng trong việc phá hủy rối loạn nhịp tim được mô tả. Sinh lý bệnh cơ bản của tác động phá hủy bằng tia xạ lên các mô tim, kinh nghiệm lâm sàng cho đến nay, và các hướng đi trong tương lai được thảo luận. Nghiên cứu tiền lâm sàng cơ bản đã chỉ ra trong các mô hình động vật lớn (lợn, chó) rằng việc cung cấp năng lượng SR đến các mục tiêu tim, đặc biệt là phá hủy nhĩ trái đối với rung nhĩ, dẫn đến bằng chứng sinh lý và mô học về tác động điều trị mà không có dấu hiệu thiệt hại. Các phương pháp điều trị lâm sàng đưa SR đến các mục tiêu thất và nhĩ đối với nhịp tim nhanh thất (VT) và rung nhĩ (AF) đã chứng minh được phản ứng lâm sàng mà không có dấu hiệu thiệt hại hay biến chứng rõ ràng cho đến nay. Trong lĩnh vực mới mẻ nhưng đầy hấp dẫn của phá hủy bằng tia xạ định vị để điều trị rối loạn nhịp tim, bằng chứng tiền lâm sàng đã chứng minh tác động điều trị mà chưa có đến nay nguy cơ thương tổn phụ lớn. Trong kinh nghiệm lâm sàng hạn chế điều trị cả rối loạn nhịp thất và nhĩ, lợi ích lâm sàng trong việc giảm rối loạn nhịp mà không có nguy cơ biến chứng đáng kể đã được quan sát. Nghiên cứu cơ chế cơ bản hơn nữa, cải tiến các phương pháp cung cấp, và tăng cường kinh nghiệm lâm sàng vẫn là điều được mong đợi và cần thiết.

Từ khóa


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