Risen from the dead: Cardiac stereotactic ablative radiotherapy as last rescue in a patient with refractory ventricular fibrillation storm

Ventricular arrhythmia storm is a potentially life-threatening clinical event that requires immediate intervention.1, 2, 3 Therapeutic strategies include antiarrhythmic drug therapy, deep sedation, cardiac pacing, catheter ablation, and the use of cardiac assist systems.1, 4 Only recently, a novel innovative therapeutic approach has been successfully established in patients with refractory ventricular tachycardia (VT). Cuculich and colleagues5 presented a series of 5 patients with recurrent VT episodes that could be successfully treated with noninvasive cardiac radiation using a single fraction of 25 Gy targeting the suspected VT exit site and the associated ventricular scar. These first promising results were further validated by a recent prospective study published by the same group that included 17 patients with refractory VT episodes and 2 patients with cardiomyopathy related to premature ventricular contractions.6 However, none of the patients published so far was treated with stereotactic radiotherapy for ventricular fibrillation (VF) storm.