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Sci Rep. 2019 Mar 21;9(1):5000. doi: 10.1038/s41598-019-41314-x.

Biological Cardiac Tissue Effects of High-Energy Heavy Ions - Investigation for Myocardial Ablation.

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GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.
Department of Science and Technology, Parthenope University of Naples, Naples, Italy.
Technische Universität Darmstadt, Institut für Festkörperphysik, Darmstadt, Germany.
Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany.
HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Germany.
DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Mayo Clinic/St. Marys Hospital, Rochester, MN, USA.
GSI Helmholtzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany.


Noninvasive X-ray stereotactic treatment is considered a promising alternative to catheter ablation in patients affected by severe heart arrhythmia. High-energy heavy ions can deliver high radiation doses in small targets with reduced damage to the normal tissue compared to conventional X-rays. For this reason, charged particle therapy, widely used in oncology, can be a powerful tool for radiosurgery in cardiac diseases. We have recently performed a feasibility study in a swine model using high doses of high-energy C-ions to target specific cardiac structures. Interruption of cardiac conduction was observed in some animals. Here we report the biological effects measured in the pig heart tissue of the same animals six months after the treatment. Immunohistological analysis of the target tissue showed (1.) long-lasting vascular damage, i.e. persistent hemorrhage, loss of microvessels, and occurrence of siderophages, (2.) fibrosis and (3.) loss of polarity of targeted cardiomyocytes and wavy fibers with vacuolization. We conclude that the observed physiological changes in heart function are produced by radiation-induced fibrosis and cardiomyocyte functional inactivation. No effects were observed in the normal tissue traversed by the particle beam, suggesting that charged particles have the potential to produce ablation of specific heart targets with minimal side effects.

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