Cardiac stereotactic radiotherapy for refractory ventricular tachycardia in a patient with wireless left ventricular endocardial stimulation system

Key Teaching Points•Cardiac stereotactic body radiotherapy (SBRT) is a salvage option for refractory ventricular tachycardia with structural heart disease.•WiSE-CRT (Wireless Stimulation Endocardially for Cardiac Resynchronization Therapy; EBR Systems, Sunnyvale, CA) is a promising leadless left ventricular endocardial pacing modality for cardiac resynchronization therapy.•We present a proof-of-concept case of successful cardiac SBRT in a patient with WiSE CRT.•In presence of cardiac implantable electronic device (CIED), especially WiSE CRT with device electronics in close proximity to the ventricular myocardium, careful SBRT treatment planning is needed to minimize radiation dose delivered to the CIED.•Cardiac SBRT in presence of CIED is considered high risk for radiation interaction and device malfunction and requires continuous patient monitoring, including video surveillance, pulse oximetry, and continuous electrocardiogram telemetry. •Cardiac stereotactic body radiotherapy (SBRT) is a salvage option for refractory ventricular tachycardia with structural heart disease.•WiSE-CRT (Wireless Stimulation Endocardially for Cardiac Resynchronization Therapy; EBR Systems, Sunnyvale, CA) is a promising leadless left ventricular endocardial pacing modality for cardiac resynchronization therapy.•We present a proof-of-concept case of successful cardiac SBRT in a patient with WiSE CRT.•In presence of cardiac implantable electronic device (CIED), especially WiSE CRT with device electronics in close proximity to the ventricular myocardium, careful SBRT treatment planning is needed to minimize radiation dose delivered to the CIED.•Cardiac SBRT in presence of CIED is considered high risk for radiation interaction and device malfunction and requires continuous patient monitoring, including video surveillance, pulse oximetry, and continuous electrocardiogram telemetry.