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Noninvasive Radiation Therapy Halts Deadly Heart Rhythm (nytimes.com)

Posted by BeauHD on from the halt-and-catch-fire dept.

schwit1 shares a report from The New York Times (Warning: source may be paywalled; alternative source): The patients were gravely ill, their hearts scarred by infections or heart attacks. In each, the electrical system that maintains a regular heartbeat had been short-circuited. They suffered frequent bursts of rapid heartbeats, which can end in sudden death. The condition kills an estimated 325,000 Americans each year, the most common cause of death in this country. And these people had exhausted all conventional treatments. So researchers at Washington University in St. Louis offered the patients something experimental: short bursts of radiation aimed at their hearts in an effort to obliterate the cells that were causing the electrical malfunctions. Results in the first five patients were published on Thursday in the New England Journal of Medicine, and the experiment seems to have worked -- offering hope to similar patients everywhere who have had no alternatives except a heart transplant. The treatment requires weeks to take full effect, so it cannot be used for cardiac patients who need immediate help. And the method must be studied in larger groups of patients over longer times, an effort that has already begun.

28 comments

  1. Big pharma to shut this down by Anonymous Coward · · Score: -1

    This would greatly reduce high profit transplant operations and lifetime use of expensive anti-rejection drugs. This must be lobbied against and shut down immediately. Radiation is dangerous people. You don't want your heart fixed to immediately find out you have cancer - a much, much worse death.

    1. Re:Big pharma to shut this down by Anonymous Coward · · Score: 1

      I think you're an idiot with typical idiot ignorance of the world as it is.

      Tachycardia is treated primarily, with Metroprolol Tartate. This has been the case since the ancient greeks. You go on to contradict your own premise by implying it would cause (costly) cancer. This is a net win by big pharma in every way you can look at it. Who do you think funded the research? Please stay in your basement, moron. The adults might have something to talk about here.

      A spot-radiation treatment is a much more costly and risky procedure than a (remaining) lifetime of beta blockers? Probably. I wouldn't risk it, as a heart patient, since there's far fewer people with ventral fib than atrial fib. Like cadaver/porcine heart valves, this looks like a specialized solution to a larger problem that is being editorialized to imply a general solution.

    2. Re:Big pharma to shut this down by Anonymous Coward · · Score: 0

      You really didn't notice the sarcasm in his post?

    3. Re:Big pharma to shut this down by Anonymous Coward · · Score: 3, Interesting

      There's a very good predictor of heart attack: the calcium score.
      Done with a CT scanner that's synchronized to the heart beat, it gives the reader the opportunity to examine the coronary arteries for calcium deposits and give an to give an estimate of the risk of a heart attack.

      Why isn't this widely adopted, instead of cholesterol and blood pressure examinations?
      Because it predicts a bit too well.
      Unnecessary statins and stent procedures are way too profitable to let go...

    4. Re:Big pharma to shut this down by Chewbacon · · Score: 5, Interesting

      That's plumbing, this is electricity. Good predictor for arrythmias: being alive. You are either born with it, or you get old enough to develop it. Sure, there are factors that correlate with getting it sooner, but you still get something eventually whether it's SVT or VT.

      --
      Chewbacon
      The Bible is like Wikipedia: written by a bunch of people and verifiable by questionable sources.
    5. Re:Big pharma to shut this down by Anonymous Coward · · Score: 5, Informative

      "A spot-radiation treatment is a much more costly and risky procedure than a (remaining) lifetime of beta blockers? Probably."
      It is more costly initially because there are so few Centers offering it. This is not your Daddy's Radiotherapy, done with Electron Linacs delivering X-Rays, or 60Co Sources delivering Gammas. Unfortunately the Delivery System is barely mentioned; they just say "Radiation" and mention a dose of 25Gy. But the pinpoint precision mentioned and the lack of damage to surrounding tissue implies Bragg Peak Radiotherapy using Ions. (Typically Protons, but Alphas and Heavy Ions have been used as well.)
      BPR is quick, not surgically invasive, and utterly painless. First developed at the 184" Cyclotron decades back, BPR depends on an obscure property of Accelerated Ions; they give up most of their Energy at the end of their paths in Matter. So Ions can go through tissue, slow down a bit, and BANG! right where they are needed, at the Bragg Peak. Stereotactic Body Radiation Therapy uses Real-Time Imaging and multiple Ports to zap just the Lesions or Tumors on such things as a beating Heart, or an AVM in the Brain.
      I am not up on the recent advances here; when I was involved in Beam Delivery years back, our Subjects were already Terminal. To put it bluntly, they were Guinea Pigs. (I frankly couldn't take the pressure, and went back into Spectroscopy instead.)
      Scale this up, and may almost be an Assembly Line affair, somewhat like LASIK is now.

    6. Re: Big pharma to shut this down by guruevi · · Score: 2

      There is no conspiracy, only cost. A CT scan sets the insurance back anywhere from $700-2500 and scheduling it is rather limited and requires at least 3-5 people to be involved. Reading your blood pressure costs $50, a blood test perhaps $150 in the high end and is rather routine can be done by a trained monkey.

      --
      Custom electronics and digital signage for your business: www.evcircuits.com
    7. Re:Big pharma to shut this down by Stroman+Rebar · · Score: 4, Informative

      I did a six week rotation at Barnes-Jewish (where Wash U does their RadOnc treatments) for my Radiation Therapy degree last December / January and witnessed one of these being done on an Edge machine. It's the most refined version of Varian's linear accelerators that they commonly use for Radiosurgery. It's on-board CT is really high resolution and nice gating capabilities (ability to turn it on only when the target area is in the right position) to allow for pretty precise delivery. I believe an additional EKG component was added to the CT based gating to ensure the radiation delivery was timed with the heart beat. Alternately, they have a ViewRay in the RadOnc department which has real-time MRI capabilities which should be able to do similar guidance.

    8. Re:Big pharma to shut this down by FreshnFurter · · Score: 1

      The article clearly stipulates what radiation and device was used.
      It is a standard Trubeam linac (Varian, Palo Alto) with Cone beam CT. Which is currently the most installed linac in American RT centers. So not extremely expensive and part of the standard machinery. So no bragg peaks in sight. I would think twice of doing this with a proton machine. (BTW I am a medical physicist and do this for a living for the last 28 years.). So a single treatment which depending on the country is between $5,000 to $25,000 . This using the equipment already available in most centers. So this is indeed SBRT, fortunately the pin point accuracy and planning has changed in the years so we are much better. BTW I never considered our patients to be guinae pigs.

    9. Re:Big pharma to shut this down by Anonymous Coward · · Score: 0

      Why would you say statins are unnecessary?

    10. Re:Big pharma to shut this down by Anonymous Coward · · Score: 0

      "The article clearly stipulates what radiation and device was used."
      No, it doesn't. I just read the NYT piece again, twice. Not one mention of the type of radiation or the method of delivery. You are reading into it prior knowledge. I just made a guess based on my own prior knowledge. X-Ray/Gamma Treatments, without Bragg Peaks, cause much more damage to surrounding tissues. This is basic Physics. (For those already lost: X-Rays and Gamma Rays are the same thing- Photons. The distinction these days is mostly Historical, with Gammas produced exclusively by Nuclear Reactions. Gamma Rays can go down deep into the historical X-Ray region. Ions are Atoms, stripped of some or all of their Electrons.)

      "BTW I never considered our patients to be guinae pigs."
      The people going through the early Bevalac Trials were already declared Terminal for other reasons. I had no part on the Medical side; my job was to Accelerate Ions and deliver them to Biomed. The Bevalac was a scary place enough; "MG11" just outside of Biomed looked like something out of a Frankenstein Movie, and in fact it predated them; it was made by Westinghouse for a Ford Plant in 1911. (It turned Six-Phase AC into ~300V, ~4000A DC.) MG11 was used for the Streamer Chamber Spectrometer Magnet.
      https://farm1.static.flickr.com/100/364025753_c0b1d00686_b.jpg

      After a couple of bad reactions to Tours, it was decided that the "Patients" were to be only given full Technical details beforehand, and in the cases of Parents of the Kids, they had to consent to the fact that this was not a Treatment without any hope of remission. This was strictly Experimental; no further Tours. So as much as possible, they saw nothing of the actual Bevalac. Biomed was in a couple of Doublewide Trailers, pleasantly painted, with comfy furniture and where Classical Music played constantly, with an isolated Bay where Ambulances could pull up.

      The Lead Biomed Accelerator Operations Biophysicist and I later worked together for a decade on unrelated projects, once the Biomed Program was defunded. She just recently retired. The basic Technology was transferred to Loma Linda for their Treatment Accelerator. It turns out that Heavy Ion Bragg Peak Radiotherapy rarely offers any significant advantages over the simpler and cheaper Protons.
      The Heavy Ion Injector, called Adam, is now being used for experimental Boron-Neutron Capture Therapy. The Ion Chambers and related Diagnostics, Vacuum Equipment, some Power Supplies, etc. went to other Accelerators. As much useful gear was recycled as possible.

      The Bevatron Site is now a Parking Lot, but construction is starting on the Integrative Genomics Building, the future home of the Joint Genome Project. The Hilac Site is now being used for advanced Accelerator Studies. The 184" Cyclotron building, where BPR started under John Lawrence, is now the Advanced Light Source, used for Synchrotron Radiation research.
      A nicely written up piece can be found here:
      https://phys.org/news/2010-10-ion-cancer-therapy.html

      I am not a Medical Physicist; I was an Accelerator guy. Accelerator guy only pawn in game of life.

      (And now a personal note: It was a Saturday morning, and I was tuning up 570MeV/n 20Ne+10 for Biomed, when a Tour came through. The Girl couldn't have been more than 16, her head already shaved, dressed in a pale blue Hospital gown. It was all too much, she broke out in tears. I was wearing a Pink Floyd Tee Shirt, and I had long hair, and I looked like a Berkeley Street Bum. (Also, I had already been up for ~12 hours.) The Bevalac Control Room was dimly lit, so that we could see the fainter Diagnostics. In a certain way, it looked like Frankenstein's Hell.
      https://cdn10.picryl.com/photo/2014/12/31/bevatron-control-room-photograph-taken-april-1-1965-bevatron-3767-5342ff-640.jpg

      And she was going to trust me to put Nuclear Bullets through her brain? I felt absolutely rotten. Medical People are trained in how to remain cool, comforting, and detached. I was not. That was the Last Patient Tour, and that was my last Tuneup for Biomed. I could remain detached about Spectroscopy.)

  2. It's freezing cold outside. by Anonymous Coward · · Score: -1

    Where the f**k is all the friggin global waming you mofos have been promising? You all are full of sh*t. It ain't happening, junior. It ain't ever going to happen. It's freezing cold for this time of year. The world is getting colder. The sun spots are diminishing and we are entering a new (hopefull "little") ice age. Better start knitting some sweaters, you mincing, swishing poof boys.

  3. How do you map non-invasively? by Anonymous Coward · · Score: 1

    I work for a medical device company and make 3D electro-anatomical maps for electrophysiologists. I'm really curious how you can map a heart without actually touching the endocardium.

    1. Re:How do you map non-invasively? by Anonymous Coward · · Score: 1

      You may use magnetocardiography, measuring the magnetic field distribution of the heart with an array of SQUID magnetometers. The magnetic field distribution can be used to identify abnormal current pathways in the heart muscle if the measurement is done during an arrhythmia event. The technique is noninvasive.

    2. Re:How do you map non-invasively? by Ungrounded+Lightning · · Score: 5, Informative

      I'm really curious how you can map a heart without actually touching the endocardium.

      Just off the top of my head:

      There are a number of non-invasive imaging technologies that can be "strobed" in synchronization with the heart's motion to produce a series of 3-D images which, together, amount to a moving picture of the cyclic activity, complete with various annotation (such as blood velocity maps, electro-chemical activity, etc.).

      One stock device for cardiologists is synthetic-aperture doppler ultrasound sonar imaging. A wide hand-held probe, with the junction to the skin joined by a slimy jelly with about the same speed-of-sound as soft tissue, connected to a high-end laptop running appropriate software, can construct such mappings in real-time, in sessions lasting minutes, annotated with blood flow information.

      Other possibilities include magnetic resonance imaging (the functional version if you want to visualize the cyclic electrochemical activity) and computer aided tomography scanning.

      And that's just for starters.

      --
      Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
    3. Re:How do you map non-invasively? by Ungrounded+Lightning · · Score: 1

      One stock device for cardiologists is synthetic-aperture doppler ultrasound sonar imaging

      Alias "echocardiogram". I get a couple of these per year just for screening:
        - One resting.
        - A couple more as a "stress echo" - one just before and one just after a session on a treadmill (or an injection of a drug if my leg joints are acting up) to pump up the heart rate and dilate the vessels.

      I also get (using the same or a similar system) occasional measurements of blood flow in various vessels, such as major arteries and veins, especially leg veins (looking for valve failures that might lead to clotting and heart attack) and the first fork of the carotid artery (where atherosclerosis can start up, leading impaired blood flow and brain damage or clotting and stroke).

      It's also good for imaging all sorts of soft organs, such as kidneys (looking for things like cysts or cancers), a foetus (looking for prenatal problems), etc.

      --
      Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
    4. Re:How do you map non-invasively? by Anonymous Coward · · Score: 2, Informative

      A lab down the hall from where I used to work used SQUIDs for some mapping of nerves in organs. It was pretty cool work and reasonably detailed (I don't remember quantitatively what the resolution was). But the SQUIDs are super sensitive. They had a Faraday cage much sturdier than what I've seen used near high power pulsed experiments, and on top of that was a bunch of mu metal shielding to block lower frequency noises. Test subjects had to remove any metal jewelry, no metal instruments were used inside the vault, and people with metal implants were not allowed to volunteer. On top of all of that shielding, they still had to cancel testing any day there was a thunderstorm within a couple hundred miles because it produced too much noise. Makes me wonder how common that problem is, e.g. do SQUID based MRI setups that use the Earth's magnetic field instead of a large DC magnet (still has some light weight excitation coils) have the same problem?

    5. Re: How do you map non-invasively? by guruevi · · Score: 1

      MRI these days is fast enough to take full images of a beating heart and resolves 3D as well (unlike echocardiogram)

      --
      Custom electronics and digital signage for your business: www.evcircuits.com
    6. Re:How do you map non-invasively? by DoctorPhillEP · · Score: 1

      Great question. The noninvasive mapping technology is called Electrocardiographic Imaging (ECGI). Patients wear a vest of electrodes (http://www.medtronic.com/us-en/healthcare-professionals/products/cardiac-rhythm/cardiac-mapping/cardioinsight-mapping-vest.html) and undergo a standard CT scan. With the vest on, we induced the life-threatening heart rhythm problem, quickly mapped it (in seconds), then rescued the patient. This mapping allowed us to see EXACTLY where the problem originated. For a living, I perform the standard mapping and ablations--we use 3D mapping with catheters routinely. But the difference between a 6+ hour catheter ablation and a 15 minute noninvasive ablation is awe-inspiring... Thanks for asking.

  4. Include white people hearts? by Anonymous Coward · · Score: 0

    Cuz white people, them pure whites, ain't got no rhythm. Everybody know dat!

  5. how did any of us survive pre-.net? by Anonymous Coward · · Score: 0

    quite nicely as i recall.. & i do.. our hearts jumped around less if we stopped smoking etc... good sports with good spirits were everywhere. constant conflict we had to invent?? so if the net went away we'd still be ok... maybe we should give the net a rest? see you on the other side of it then... don't forget all we need is what comes from above...

    1. Re:how did any of us survive pre-.net? by Anonymous Coward · · Score: 0

      "don't forget all we need is what comes from above..."

      Sunshine? Yup. Get your daily vitamin D!

  6. back to real time pile sharing then? by Anonymous Coward · · Score: 0

    as the coin of the realm is kaput in so far as being useful to us overwhelming majority ordinarians are concerned... see you soon...say bud can you front me a spud until my radishes are harvestable?

  7. But what's the long-term prognosis? by dgatwood · · Score: 4, Interesting

    Unfortunately, the last sentence hints that this was a short-term study. I'm a little skeptical that a long-term study will be nearly as positive.

    Cardiac ablation techniques have been used for treating atrial fibrillation for many years now. The problem is that after a few years, the heart finds new ways to route those bad signals through itself, and the fibrillation comes right back. I kind of expect the same thing to happen with ablation for v-tach.

    --

    Check out my sci-fi/humor trilogy at PatriotsBooks.

    1. Re:But what's the long-term prognosis? by Anonymous Coward · · Score: 0

      Unfortunately, the last sentence hints that this was a short-term study. I'm a little skeptical that a long-term study will be nearly as positive.

      Cardiac ablation techniques have been used for treating atrial fibrillation for many years now. The problem is that after a few years, the heart finds new ways to route those bad signals through itself, and the fibrillation comes right back. I kind of expect the same thing to happen with ablation for v-tach.

      Does a maze procedure have the same drawback? I'd really rather not get my chest cracked open again.

    2. Re:But what's the long-term prognosis? by Anonymous Coward · · Score: 2, Informative

      I believe your estimation of the futility of cardiac ablation is a decade out of date. Particularly those with paroxysmal afib the outcomes are much better than that.

    3. Re:But what's the long-term prognosis? by dgatwood · · Score: 1

      That's quite possible; the people I know who have had the procedure with only short-term success did have it a decade or so back. Then again, at any given point in time, you can look at it and say that it is working for the recent patients... until it no longer is... hence my cynical skepticism. :-)

      --

      Check out my sci-fi/humor trilogy at PatriotsBooks.

    4. Re:But what's the long-term prognosis? by SBRT_CR · · Score: 4, Informative

      Excited to see the dialogue about this! Ventricular tachycardia is a very different beast than atrial fibrillation. Medication and catheter ablation for afib is quite effective in most patients. Afib is not life threatening for most. In contrast, VT is very life threatening, and most patients would die from their VT if they didn't have an implanted defibrillator. Likewise, medications and catheter ablation for VT is less effective. Furthermore, once someone becomes refractory to standard VT therapies, their chances of dying from the VT become substantial. Likewise, options for these sick patients are quite limited - heroic attempts at repeat ablation, heart transplant, or even hospice. We employed a unique combination of non-invasive mapping of the VT using a "vest" of electrodes which can 3-dimensional map the VT (ECGI) and combined it with a known non-invasive ablative therapy (SBRT) which I typically use to treat tumors. SBRT is precise, focused, and has been used in thousands of patients. SBRT to the diseased part of the heart causing the VT is what makes this special. You are appropriately skeptical about the long term benefit of such a treatment. Standard therapies fail more than 50% of the time. We aren't proposing that this would necessarily be superior to standard therapies, but certainly provides an alternative to those with no alternatives. With time, it might even become a viable option for more patients. We are carefully studying this now in a prospective trial after we saw these initially encouraging results. We must be diligent about monitoring for unexpected toxicities and results. Thank you for your comments, and for keeping us honest. https://clinicaltrials.gov/ct2...