For the first time in Utah, Intermountain Health doctors have performed an innovative new procedure using radiation therapy typically applied to treat cancer patients to cure a life-threatening irregular heartbeat in a heart patient, paving the way for other Utah heart patients to benefit from this unique treatment.
Intermountain Health cardiologists and radiation specialists successfully performed this Utah medical first using stereotactic radiotherapy – an outpatient procedure typically performed on cancer patients – on two patients after other standard cardiac procedures failed to correct their potentially life-threatening heart arrhythmia, known as refractory ventricular tachycardia (VT).
This unique collaboration between the Intermountain Health heart & vascular and radiation oncology programs led to the first two ever procedures performed in Utah and provides renewed hope for heart arrhythmia patients who don’t respond to standard cardiac therapy.
The procedure – stereotactic radiotherapy – is an outpatient procedure typically performed on cancer patients. For Shannon Brooks, it was a life-saving option after other standard cardiac procedures failed to correct his potentially life-threatening heart arrhythmia.
Refractory ventricular tachycardia, which is a common heart disease is a potentially life-threatening heart arrhythmia that occurs in the organ’s lower chambers in patients with heart disease or heart failure and may lead to sudden cardiac death. While there are a variety of treatments, not all of them work for people suffering from the disorder.
Brooks and his family were surprised when he had a VT episode right after Christmas Eve.
He experienced a heart attack when he was 37 years old, which is where his heart issues first began, resulting in the need to get a defibrillator. He had received a successful ablation following that heart attack and was able to go about life.
These cardiac catheter ablation surgeries use heat or cold energy to create tiny scars in the heart to block irregular electrical signals to restore his heartbeat.
Unfortunately, this method doesn’t always work, and Brooks found himself going into cardiac arrest 18 years later on New Year’s Day, where his son performed CPR on him for seven minutes to save his life.
“Catheter ablation for VT utilizes radiofrequency energy delivered through the tip of a catheter to heat up and destroy heart tissue. A limitation of catheter ablation is the ability to create adequate ablation lesions to the affected areas of the heart which can result in recurrent VT,” said Michael Cutler, MD, associate medical director for EP at the Intermountain Health Heart & Vascular Program, who treated Brooks at Intermountain Medical Center in Murray.
Brooks was admitted to IMED a few times following his cardiac arrest where he learned that the treatments he previously had were no longer working, and was under severe heart failure.
His only option was to get listed on the national heart recipient transplant list, until the Intermountain Health cardiologists recommended he consider stereotactic radiotherapy, a standard cancer treatment, but a new option available to treat his heart arrhythmia at IMED, as a final opportunity.
“This method of treatment allows us to use focal, high dose radiation to treat refractory ventricular tachycardia with electrophysiology-guided targeting,” said Grant Hunter, MD, an Intermountain Health radiation oncologist, who helped treated Brooks. “The radiation is able to target the region of the heart while being delivered in an out-patient setting.”
“For specifically-selected patients, who really have few options, this new stereotactic radiation treatment can be a game-changer,” added Dr. Hunter. “The chance to treat these high-risk patients with a non-invasive treatment is a novel and exciting option.”
With the collaboration between the Intermountain heart & vascular and radiation oncology programs, Drs. Cutler (cardiology), Grant Hunter (oncology), and Peter Hu (cardiac imaging) led this first-ever procedure held in Utah – a medical milestone for the state that holds new promise for heart patients, like Brooks, who don’t respond to standard cardiac care.
“We utilized non-invasive, multi-modality imaging such as echocardiography, nuclear PET, and CT, and combined this with Dr. Cutler's 3D map of the heart to help guide the stereotactic radiotherapy procedure with Dr. Hunter,” said Peter Hu, MD, medical director of cardiac molecular imaging at Intermountain Medical Center.
“Overall, the planning process was a collaborative and successful effort with cardiac Imaging, EP, and radiation oncology to provide a non-invasive option for the patient's life-threatening arrythmia,” he added.
Fortunately, the procedure was a success and Brooks, who is in his mid-50s, was ecstatic with the outcome and the opportunity to be one of the first two patients to have this procedure performed in Utah.
“It’s terrifying to be told Shannon’s in heart failure and that he needed to have a heart transplant,” said Brooks’ wife, Jen Brooks. “We would have had no other option but to live in the hospital and wait for his transplant.”
The procedure is performed at only a few sites nationally for cardiac patients. It takes place in the radiation oncology clinic as an outpatient procedure at Intermountain Medical Center.
“Stereotactic radiotherapy utilizes a different energy source and delivery method than what we typically use to create ablation lesions to these affected areas of the heart thus, disrupting the cause of the VT,” said Dr. Cutler.
Patients who receive this non-invasive procedure are considered part of an outpatient procedure. The patient is awake and in an immobilization device where the radiation beam will be aimed in the area where the radiation will be treating the body. This is similar to a CT scan. Given that the procedure is non-invasive, the patient is awake and doesn’t feel any poking or prying, nor needs to go under anesthesia.
Generally, the patient can go home on the day of the procedure and is able to resume normal activity shortly after. In Brooks’ case, he felt well enough to go to lunch after his procedure and went home the same day.
“I knew the doctors knew what they were doing. It was crazy to see how many were caring for me,” says Brooks. “I’m thankful that my doctors cared for me. You could tell they work hard for all of their patients and care for them. I knew they knew what they were doing.”
It has been three weeks since Brooks had this procedure, and the things he looks forward to doing most is playing with his grandchildren, guitar, visit the shooting range with his son, attend concerts, and celebrate his 30th wedding anniversary with his sweetheart, Jen.
“We were feeling pretty hopeless and this procedure brought us a new perspective. We’re so grateful,” said Jen. “This could have been a different story.”