Physicians Use New Radiation Procedure to Treat Deadly Heart Arrhythmia

Despite receiving top-notch treatment from physicians at Baptist Health in Miami, Florida, Jose Manuel Garcia was very sick, and he was getting worse.

Garcia had an extensive history of heart problems. He’d had a coronary artery bypass graft operation to open up blocked heart arteries in 2004. After surgery, he developed a condition known as ventricular tachycardia (VT).

To treat his VT, Garcia received a permanent pacemaker with an automatic implantable cardioverter defibrillator (AICD) in 2010. He received an upgraded device in January 2020. But by May 2020, Garcia required another operation. During this surgery, he underwent a VT ablation procedure to help reduce his frequent episodes of ventricular tachycardia. Essentially, a cardiologist “burned” and created scar tissue to parts of Garcia’s heart so they would no longer generate irregular beats.

No Sign of Improvement

In spite of the procedure, multiple medications, and an implanted internal cardiac defibrillator to shock his heart during VT episodes, Garcia continued to decline. This is common for people who experience VT—it’s a tricky condition to treat, and experts say most available therapies are only 40% effective. As the condition worsens, so does heart function.

Garcia was admitted to the hospital three times in seven weeks for recurrent VT.

Garcia developed heart failure, the inability of the heart muscle to pump effectively. His wife had to push him in a wheelchair when he came to appointments because he was too fatigued to walk.

A New Approach

Garcia’s electrophysiologist, Mario Ignacio Pascual, MD, of Baptist Health’s Miami Cardiac & Vascular Institute, did not feel that Garcia could tolerate another ablation procedure, so he decided to suggest an innovative approach that had only been tried on a small number of patients at the time.

Pascual collaborated with Rupesh Rajesh Kotecha, MD, a board-certified radiation oncologist at Baptist Health’s Miami Cancer Institute, and a multidisciplinary team of other professionals. Together, they treated Garcia with stereotactic body radiation therapy (SBRT), which is usually used to treat cancer. The team refers to the procedure as “radioablation.”

Their goal was to target the areas of Garcia’s heart that continued to trigger episodes of VT using high-dose, precision radiation instead of the radiofrequency ablation used in traditional cardiac ablation.

In addition to Pascual and Kotecha, Garcia’s treatment team included other expert cardiologists and radiation specialists. They looked extensively at scans of Garcia’s anatomy to ensure that they could target the diseased areas of Garcia’s heart with the proper dose of radiation while avoiding damaging other critical surrounding structures.

“We usually try to avoid any dose of radiation to the heart,” Kotecha tells Verywell. “This is essentially the opposite. We deliver the highest possible dose of radiation to one specific point of the heart, visualized well. This process takes extensive collaboration with an entire team. It requires us to be thoughtful about the procedure.”

Pascual agrees that every member who is involved plays a vital role in the outcome.

“Without a multidisciplinary approach, I just don’t see success with this procedure,” he says.

Since undergoing radioablation on January 28, Garcia’s condition has improved drastically, Pascual tells Verywell. He’s had no further episodes of VT. Instead of taking three medications to control his heart rhythm, he is now taking just one. And his heart muscle is pumping more efficiently again.

Radioablation is a shorter and less invasive procedure than traditional ablation. Patients can usually go home the same day, and they have shorter recovery periods.

Who Is a Candidate for Radioablation?

Pascual tells Verywell Health that certain patients are more suitable candidates for radioablation than others.

“If you’ve done multiple V-tach ablations yet you’re still not having success in controlling it, you have to consider other strategies,” he says.

Ablation catheters cannot reach certain areas of the heart. Some patients are unable to tolerate sedation, which is necessary for ablation. And even under the best of circumstances, VT ablation only has about a 50% to 70% success rate.

Still, radioablation should be reserved for patients who do not respond to standard treatments first.

“Some patients may need radiation for cancer in the future, and we don’t want to burn that bridge,” Kotecha explains, adding too much radiation is unsafe.

“We have a lot of data on conventional VT ablation,” Pascual adds. “We understand its acute and long-term success rates and risks. If we have a good candidate for a traditional VT ablation, we still go that route.”