Safety and Efficacy of Stereotactic Cardiac Radio-Ablation for Ventricular Tachycardia in Patients at High Risk of Mortality
Bibliographic record
Abstract
Background: Patients who have recurrent ventricular tachycardia (VT) despite receiving antiarrhythmic drugs (AADs), implantable cardioverter defibrillator placement, and catheter ablation (CA) are at significant risk of morbidity and mortality. Methods: We offered completely noninvasive cardiac radio-ablation (CRA) on a "compassionate use" basis for patients who were unable or unwilling to undergo CA for recurrent VT despite their having received treatment with AADs and placement of an implantable cardioverter defibrillator. All patients who were referred to the CRA program were entered into a prospective registry and followed indefinitely thereafter. Results: A total of 20 patients were referred for CRA, and 10 elected to undergo the treatment as outpatients. Ten patients declined CRA therapy, owing to fear of complications and/or logistic concerns relating to attending multiple hospital visits; they received escalated drug therapy. All patients who were referred to and were agreeable to CRA received CRA. No patients were excluded or were denied CRA by clinicians for any reason, and all patients were followed clinically. The VT burden decreased significantly, by > 90% (both anti-tachycardia pacing and shocks), and 1 patient died of a cardiovascular cause at 1 year following a single CRA treatment of 25 Gy. One patient experienced steroid-responsive pneumonitis as an adverse event post-CRA (common terminology criteria for adverse events [CTCAE] grade 2). For the 10 patients who declined CRA, no appreciable reduction in VT occurred, despite their receipt of increasing dosages of AADs, and 5 patients died of cardiovascular causes within 1 year. Conclusions: Noninvasive stereotactic CRA is well tolerated with good short-term efficacy for recurrent VT on a "compassionate use" basis. Prospective randomized controlled trials to determine the relative efficacy of CA vs CRA for VT are urgently required.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".