A multidisciplinary team at Life Vincent Pallotti Hospital in Cape Town successfully carried out an advanced procedure to treat a life-threatening heart rhythm disorder in a patient whose condition had not responded to standard treatment options.
The treatment combined catheter ablation with planning for Non-invasive Stereotactic Arrhythmia Radiotherapy Ablation (STAR), an emerging approach that uses highly-targeted radiation therapy to treat abnormal heart tissue without surgery.
The hospital says the procedure places the Cape Town team among the first in Africa capable of combining advanced three-dimensional electrical heart mapping with precision cardiac radiation therapy planning for complex heart rhythm disorders.
The approach is based on international developments in cardiac stereotactic radio ablation, including the ENCORE-VT study conducted at Washington University in St Louis, which showed meaningful reductions in dangerous heart rhythm episodes in patients who had not improved with conventional treatment.
“We have started treating patients suffering life-threatening abnormal heart rhythms by combining advanced cardiac electrophysiology techniques with precision stereotactic radiotherapy planning normally used in the treatment of cancer,” says Dr Vinod Thomas, cardiac electrophysiologist and leader of the project.
“This approach provides an important treatment pathway for patients who have exhausted conventional therapies and who continue to suffer recurrent ventricular tachycardia and repeated ICD shocks despite multiple procedures and maximal medical therapy.”
The patient
According to the hospital, the patient, 61-year-old Sydney Clarence Hoogbaard, had been living with a weakened heart muscle condition and severely reduced heart function, with his heart pumping at just 21%, well below the normal level of above 55%.
It explains that he had experienced repeated episodes of ventricular tachycardia, a dangerous abnormal heart rhythm, and multiple shocks from his implantable cardioverter-defibrillator (ICD), a device designed to detect and correct life-threatening rhythm disturbances.
Despite receiving several forms of treatment, including heart rhythm medication, heart failure therapy, intravenous Amiodarone and Lignocaine, his condition continued to worsen.
The hospital points out that during one hospital admission, he received 12 ICD shocks within a single hour.
Doctors noted that repeated ICD shocks can severely affect quality of life and have also been linked in studies to poorer long-term outcomes.
Hoogbaard had already undergone several ablation procedures over an 18-month period at other hospitals, including surgery targeting the outer surface of the heart. However, the operation resulted in internal scarring that prevented doctors from using conventional treatment routes again.
To treat the condition, the clinical team used advanced electrical heart mapping together with cardiac CT imaging to identify scar tissue and abnormal rhythm pathways inside the heart.
Doctors found evidence suggesting involvement of tissue on the outer surface of the heart and included this in a combined electrical and imaging model to guide future radiation-based treatment if needed.
The STAR approach combines expertise from cardiac electrophysiology, advanced imaging and precision radiation therapy. Electrical mapping identifies the exact area causing the abnormal rhythm, while CT imaging creates a detailed three-dimensional picture of the damaged tissue.
Radiation specialists can then deliver focused radiation beams with sub-millimetre precision directly to the affected area.
Medical collaboration
After the initial ablation, the hospital notes that the patient experienced additional ICD shocks. Further heart rhythm analysis confirmed the abnormal rhythm was coming from the previously identified area on the outside of the heart, it adds.
Using cardiac CT data, radiologists developed a three-dimensional heart model and converted it into treatment coordinates to support precise radiation planning.
The procedure involved collaboration between cardiac electrophysiologists, radiologists and radiation oncology specialists.
Following the extensive ablation procedure, doctors were unable to trigger any further ventricular tachycardia.
According to the hospital, Hoogbaard remained stable after treatment and was monitored in intensive care for several days without recurrence of abnormal heart rhythms or additional ICD shocks.
Doctors reported improvements in his blood pressure, circulation and overall condition.
“This technique allows us to treat portions of the heart non-invasively using highly-targeted radiation therapy traditionally used in cancer treatment,” says Dr Louis Kathan, a Cape Town-based radiation oncologist with expertise in stereotactic body radiotherapy and advanced precision radiation techniques.
“For carefully selected patients with refractory ventricular tachycardia, this may offer an important therapeutic option where conventional procedures are no longer feasible.”
The doctors say ventricular tachycardia remains one of the leading causes of sudden cardiac death among patients with structural heart disease.
The case also highlights the growing role of collaboration between heart rhythm specialists, radiologists and radiation oncologists in delivering highly-specialised treatment locally using South African expertise and infrastructure.
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