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Catheter interventions frequently have to be repeated due to recurrent arrhythmia, can have rare but severe side\u2010effects and are less suited especially for potentially lethal left ventricular tachycardia. Noninvasive alternatives are therefore warranted. Photon and ion beam radiotherapy has been studied in animal models and first patient cases have been reported using photons. Ion beams might offer the possibility to greatly reduce dose to surrounding healthy tissue, including critical cardiac substructures.<\/jats:p><jats:p>Based on a recently conducted animal study, we report advantages and disadvantages of 4D\u2010ion beam therapy, and strategies necessary for a clinical transition. Motion management of both respiration and heartbeat are discussed, as well as range uncertainty resulting from both regular motion and interfractional anatomic changes. Image guidance both in 3D and 4D has to be employed for a safe irradiation, but also population\u2010based data on motion variability and time behavior of interfractional changes are necessary. Range verification could play a crucial role at least during development of clinical protocols.<\/jats:p><jats:p>For clinical realization, it appears necessary to suppress or conformally mitigate the large respiratory motion to avoid normal tissue complications. Cardiac motion has to be incorporated into treatment planning, either through adequate range\u2010considering internal margins or through more conformal strategies such as ECG\u2010based gating or even 4D\u2010optimization. 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