Baptist Health Heart & Cancer Experts Join Forces To Perform Florida’s First Stereotactic Body Radiation Therapy Procedure To Treat Ventricular Tachycardia
Rarely Performed in the United States, the Non-Invasive Procedure Puts 77-Year-Old, Critically Ill
Heart Patient on the Road to Full Recovery
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MIAMI – March 18, 2021 – Baptist Health’s Miami Cardiac & Vascular Institute and Miami Cancer Institute joined forces to successfully perform Florida’s first-ever stereotactic body radiation therapy (SBRT) procedure on a 77-year-old male patient with ventricular tachycardia (VT), a potentially fatal heart rhythm disorder caused by abnormal electrical signals in the lower chambers of the heart.
SBRT to treat VT is a noninvasive outpatient procedure that takes only a few minutes to administer and requires no anesthesia or hospitalization. It involves the use of electrocardiograms and computed tomography scans of a patient’s heart to pinpoint the origin of the arrhythmia, utilizing the 3D visual of the heart as a guide for the radiation therapy. Doctors target the area of the heart causing the arrhythmia with a single, high-dose treatment of radiation therapy.
The procedure was led by Mario Pascual, M.D., cardiologist and cardiac electrophysiologist at Miami Cardiac & Vascular Institute, and Rupesh Kotecha, M.D., radiation oncologist and chief of radiosurgery at Miami Cancer Institute. Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program and Elliott Elias, M.D., a cardiologist with a focus on interventional echocardiography, both at Miami Cardiac & Vascular Institute, were also key members of the team.
While SBRT is quite commonly performed in radiation oncology and a standard radiation treatment offered at Miami Cancer Institute for a variety of cancer indications, its application to treat heart arrhythmia disorders is rare with few centers around the world providing this unique treatment due to the unique multidisciplinary collaboration required for the procedure.
“Despite heart disease and cancer being the top two causes of death in the United States and worldwide, cardiac and radiation teams typically don’t interact,” said Dr. Pascual. “This procedure truly requires a multidisciplinary approach. If we look at who was involved, it was an electrophysiologist, our advanced heart failure team, our general cardiologist, our cardiac imaging specialist, and radiation oncology team. In total, it took five specialists to come up with a treatment plan for this patient.”
The critically ill heart patient, Jose Manuel Garcia, was experiencing dizziness, some shortness of breath, and recurrent episodes of passing out before undergoing the SBRT procedure. Prior to the procedure, Mr. Garcia’s cardiology team at Miami Cardiac & Vascular Institute was led by Jonathan Fialkow, M.D., deputy director and chief of cardiology.
In the weeks leading up to the procedure, Mr. Garcia had to be stabilized with drug therapies after experiencing cardiogenic shock, a serious condition when the heart cannot pump enough blood and oxygen to the brain, kidneys, and other vital organs, explains Dr. Chaparro. His VT and congestive heart failure had contributed to a left ventricular ejection fraction (LVEF) of 10 percent. The normal LVEF range is from 55 to 70 percent. During his procedure, Mr. Garcia had to be medically stable, and remain awake and alert to follow directions from physicians.
“As a team, we spent multiple nights prior to the procedure reviewing the imaging since the scans are interpreted differently amongst our practices. It was about getting on the same page to understand both the target and the treatment,” said Dr. Kotecha. “We also consulted with our colleagues at Washington University School of Medicine in St. Louis who have experience performing this procedure on VT patients. Their feedback was invaluable.”
The standard treatment options for VT patients include implantation of defibrillators that shock the heart back into a normal rhythm and catheter ablation procedures, in which a catheter is inserted into the heart and manipulated to create scars in the part of the damaged heart muscle responsible for the misfiring of electrical signals. In sharp contrast to SBRT, catheter ablations are invasive and require many hours under general anesthesia. Moreover, for many patients, it is often not a permanent solution, with rapid heart rhythm returning in approximately half of these patients. Additionally, the recovery time is much longer.
“If we look at our standard catheter ablation procedure, I know this patient would have had a prolonged hospital stay in our Intensive Care Unit,” said Dr. Pascual. “But the day we did the SBRT, the patient literally got off the table, spent 20 minutes in a room under observation and then left to go home for dinner. Since then, he’s continued to feel better each day and has not had any side effects whatsoever.”
As a result of the successful SBRT procedure, future VT patients who have exhausted other treatments will be evaluated by the multidisciplinary team on whether they could benefit from this landmark procedure.
“If a patient can derive clinical benefit from this treatment, then our entire cardiology team will evaluate future potential patients to ensure that they would be a good candidate for this procedure,” said Dr. Kotecha. “We will then work to develop a radiation plan together, just like we did for this first patient.”
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