Technical aspects of SBRT for therapy-refractory ventricular tachycardia: a systematic review for radiation oncologists

BACKGROUND: Ventricular tachycardia (VT) is a potentially life-threatening arrhythmia, that can lead to sudden cardiac death. While conventional treatments include antiarrhythmic drugs, catheter ablation, and ICD implantation, recent studies suggest that stereotactic body radiotherapy (SBRT) offers a non-invasive alternative for the treatment of VT. The objective of this systematic review is to summarize the current evidence on SBRT for refractory VT from a radiotherapeutic and technical perspective and to assess its safety and effectiveness. METHODS: he systematic search was conducted according to the PRISMA guidelines, using the four databases PubMed, Cochrane, Scopus, and Web of Science. After screening, 15 publications were included and analyzed in this review. RESULTS: A total of 15 studies were identified in the literature, describing 173 patients. SBRT was delivered as a single fraction using standard LINAC- or CyberKnife-devices with varying isodose prescriptions, motion management, and imaging guidance, highlighting the need for standardized protocols. SBRT consistently reduced VT burden across these studies, with reduction rates ranging from 50 to 99%, and improved quality of life in some patients. However, VT recurrences have also been described. CONCLUSION: Delivery of SBRT for VT is similar to that for malignant diseases but requires specialized imaging and mapping procedures to ensure precise delivery of radiation to small ectopic areas within the beating heart. SBRT seems safe and effective in reducing VT in first clinical trials, though it is not yet a routine treatment. Further controlled trials with standardized treatments and endpoints are needed for confirmation. CLINICAL TRIAL NUMBER: This study does not involve a clinical trial; therefore, a clinical trial number is not applicable. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13014-025-02704-w.