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For patients who do not respond to conventional therapies, including antiarrhythmic drugs and catheter ablation (CA), stereotactic body radiotherapy (SBRT)\u2014also known as stereotactic arrhythmia radioablation (STAR)\u2014has emerged as a promising non-invasive alternative. This review synthesizes current clinical evidence from prospective trials, retrospective series, and case reports that collectively demonstrate the efficacy of STAR in reducing VT burden and improving quality of life. This review also explores the evolving understanding of the associated underlying biological mechanisms, which appear to involve a complex interplay between early electrophysiological conduction reprogramming and delayed structural myocardial remodeling mediated by inflammation and fibrosis. Finally, we address the critical technical considerations, including patient selection, target delineation using multimodal imaging and electroanatomic mapping, motion management, and treatment planning, which are essential for the safe and effective delivery of STAR. While short-term outcomes are encouraging, ongoing research is needed to optimize dosing, refine techniques, and establish long-term efficacy and safety.<\/jats:p>","DOI":"10.31083\/rcm49589","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["Stereotactic Body Radiotherapy for Refractory Ventricular Tachycardia: From Serendipity to Precision Biological Ablation"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8295-403X","authenticated-orcid":true,"given":"Zhoushan","family":"Gu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Nantong University, 226001 Nantong, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3079-7309","authenticated-orcid":true,"given":"Zhou","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-821X","authenticated-orcid":true,"given":"Youmei","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7763-5368","authenticated-orcid":true,"given":"Linsheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Affiliated Hospital of Nantong University, 226001 Nantong, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4867-5341","authenticated-orcid":true,"given":"Hailei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9844-486X","authenticated-orcid":true,"given":"Minglong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital with Nanjing Medical University, 210029 Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Sapp JL, Tang ASL, Parkash R, Stevenson WG, Healey JS, Gula LJ, et al. 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