Hospital del Mar in Barcelona is the first in Spain and one of the first in the world to use radiotherapy to cure heart arrhythmias. This pioneering technique has already been applied to a patient. The initiative allows treating patients in whom the usual techniques had been unsuccessful, being doomed to heart transplantation.
The application of radiotherapy for arrhythmias has its origin in the USA, where it has been used in about twenty cases. The aim is to administrate the heart’s area where this dysfunction originates a very high dose of radiation (25 Grays in a single session, when the usual is a dose of 2 Grays to treat cases of cancer), in order to create a scar in the area and thus eliminate the arrhythmia.
The intervention was carried out on December 21st; and so far, the arrhythmias have disappeared completely without side effects due to radiation.
The head of the Cardiology Service of Hospital del Mar, Julio Martí, highlights the complexity of the technique, which requires a high degree of specialization of the professionals involved. “You have to work together. First of all radiologists, who are the ones who obtain the images; then the cardiologists, to indicate the point at which the problem originates; and, finally, radiotherapy oncologists, who define the volume to be treated and how to do it,” he explains.
It is a short-term intervention; it only takes 30 minutes. It is done under the supervision of a cardiologist to deal with possible complications.
The patients who can benefit from this technique are patients with epicardial pathology, where the arrhythmia originates in the outer zone of the cardiac muscle; also those with ischemic pathologies, in which the lesion is located in the external zone of the heart; patients with cardiac problems due to Chagas disease, and those with some ischemic pathology in scar phase that affects the epicardium, which cannot be accessed from the inside.
They are cases in which this technique is the most indicated, since, according to Martí, “the fundamental advantage is that the area to be treated is difficult to access using the usual catheterization techniques. With [the radiation technique], you can define perfectly the volume and the area to be treated.”
A case of high complexity
The first patient treated with this technique is a 64-year-old man who suffers from a cardiac pathology called arrhythmogenic dysplasia of the right ventricle, in which the heart muscle is replaced by adipose tissue and ventricular arrhythmias are more easily produced.
In this case, he already had three unsuccessful ablations, the last one last October. The patient had a defibrillator inserted in the heart to avoid cardiac arrest, but the device was no longer useful because of the damage the disease had caused in the heart muscle.
The intervention was carried out on December 21 and, until now, the arrhythmias have disappeared completely, without secondary effects due to radiation. Keep in mind that, with this technique, unlike others, the response to radiation is slower and the positive effects take a little longer.
This case is the second one with this pathology treated in the world with radiotherapy. Arrhythmogenic dysplasia of the right ventricle is a rare disease, of unknown origin and originally described only 42 years ago. The exact incidence is unknown, although it is more common in men and has a higher prevalence in athletes.
The project received the award for the best communication at the Fifth Joint Meeting of the Sections of Electrophysiology and Arrhythmia and Cardiac Stimulation of the Spanish Society of Cardiology (SEC), which was held in Barcelona between March 6 and 8.