Focus on stereotactic radiotherapy: A new way to treat severe ventricular arrhythmias? - Archive ouverte HAL
Article Dans Une Revue Archives of cardiovascular diseases Année : 2021

Focus on stereotactic radiotherapy: A new way to treat severe ventricular arrhythmias?

Frédéric Sacher
  • Fonction : Auteur
Philippe Maury
  • Fonction : Auteur
Catherine Jenny
Jonathan Khalifa
  • Fonction : Auteur
Serge Boveda
  • Fonction : Auteur
Pascal Defaye
  • Fonction : Auteur
Daniel Gras
  • Fonction : Auteur
Didier Klug
  • Fonction : Auteur
Gabriel Laurent
  • Fonction : Auteur
Nicolas Lellouche
  • Fonction : Auteur
Jacques Mansourati
Eloi Marijon
Olivier Piot
Jerome Taieb
  • Fonction : Auteur
Hubert Cochet
  • Fonction : Auteur
  • PersonId : 880054
Philippe Maingon
  • Fonction : Auteur
Etienne Pruvot
  • Fonction : Auteur
Laurent Fauchier

Résumé

Abstract Recent developments in imaging, mapping, and ablation techniques have shown that the epicardial region of the heart is a key player in the occurrence of ventricular arrhythmic events in several cardiac diseases, such as Brugada syndrome, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy. At the atrial level as well, the epicardial region has emerged as an important determinant of the substrate of atrial fibrillation, pointing to common underlying pathophysiological mechanisms. Alteration in the gradient of repolarization between myocardial layers favouring the occurrence of re-entry circuits has largely been described. The fibro-fatty infiltration of the subepicardium is another shared substrate between ventricular and atrial arrhythmias. Recent data have emphasized the role of the epicardial reactivation in the formation of this arrhythmogenic substrate. There are new evidences supporting this structural remodelling process to be regulated by the recruitment of epicardial progenitor cells that can differentiate into adipocytes or fibroblasts under various stimuli. In addition, immune-inflammatory processes can also contribute to fibrosis of the subepicardial layer. A better understanding of such ‘electrical fragility’ of the epicardial area will open perspectives for novel biomarkers and therapeutic strategies. In this review article, a pathophysiological scheme of epicardial-driven arrhythmias will be proposed.
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hal-04007616 , version 1 (15-03-2023)

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Frédéric Sacher, Estelle Gandjbakhch, Philippe Maury, Catherine Jenny, Jonathan Khalifa, et al.. Focus on stereotactic radiotherapy: A new way to treat severe ventricular arrhythmias?. Archives of cardiovascular diseases, 2021, 114 (2), pp.140-149. ⟨10.1016/j.acvd.2020.11.003⟩. ⟨hal-04007616⟩
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