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Treatment Planning Studies in Patient Data With Scanned Carbon Ion Beams for Catheter‐Free Ablation of Atrial Fibrillation
Author(s) -
CONSTANTINESCU ANNA,
LEHMANN H. IMMO,
PACKER DOUGLAS L.,
BERT CHRISTOPH,
DURANTE MARCO,
GRAEFF CHRISTIAN
Publication year - 2016
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12888
Subject(s) - medicine , ablation , atrial fibrillation , catheter ablation , nuclear medicine , radiation treatment planning , radiation therapy , cardiac resynchronization therapy , pulmonary vein , cardiology , radiology , ejection fraction , heart failure
Noninvasive AF Ablation With Carbon Ions Introduction Catheter ablation with isolation of the pulmonary veins is a common treatment option for atrial fibrillation but still has insufficient success rates and carries several interventional risks. These treatment planning studies assessed if high‐dose single fraction treatment with scanned carbon ions ( 12 C) can be reliably delivered for AF ablation, while sparing risk structures and considering respiratory and contractile target motion. Methods and Results Time resolved CT scans of complete respiratory and cardiac cycles of 9 and 5 patients, respectively, were obtained. Ablation lesions and organs at risk for beam delivery were contoured. Single fraction intensity‐modulated particle therapy with target doses of 25 and 40 Gy were studied and motion influences on these deliveries mitigated. Respiration had a large influence on lesion displacement (≤ 2 cm). End expiration could be exploited as a stable gating window. Smaller, but less predictable, heartbeat displacements (< 6 mm) remained to be mitigated because cardiac contraction resulted in insufficient dose coverage (V95 < 90 %) if uncompensated. Repeated irradiation ( 12 C beam rescanning) during breath hold was used to accommodate contractile motion, resulting in good dose coverage. Dose depositions to all organs at risk were carefully examined and did not exceed values for X‐ray cancer treatment. Conclusion Treatment planning of 12 C with delivery of physical ionizing radiation doses that have been described to induce complete block is feasible for AF ablation, considering human anatomy, dose constraints, and encasing underlying motion patterns from respiration and cardiac contraction at the LA–PV junction into treatment planning.