Case Series of Transcutaneous Magnetic Stimulation for Ventricular Tachycardia Storm

Markman, Timothy M.; Hamilton, Roy H.; Marchlinski, Francis E.; Nazarian, Saman

doi:10.1001/jama.2020.3833

Cited by 15 publications

(16 citation statements)

References 11 publications

(18 reference statements)

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“…Unlike the sympathetic regulation methods described above, indirect regulation methods require the placement of “receptors” inside or on the surface of the body that can sense specific external stimulus, and then the use of external energy such as electromagnetic fields (EMF) to signal to the “receptors,” and the “receptors” then exert their effects on neural activity. Transcranial EMF stimulation has been used to treat a variety of neurological disorders such as depression ( 196 ), Wang et al ( 197 ) found that intermittent low-frequency EMF stimulation of the left stellate ganglion (LSG) significantly reduced the incidence of VAs after myocardial ischemia in an animal model, and the first-in-man application of low-frequency EMF stimulation was described in a subsequent series of case reports ( 198 ), which included 5 patients with sympathetic electrical storms who had failed to respond to pharmacological treatment, the electromagnetic coil was placed on the surface of the seventh cervical spine near the LSG, and intermittent low-frequency EMF stimulation was administered, showing a significant reduction in the incidence of VAs and no device-related AEs. The STAR-VT study (NCT04043312) on low-frequency EMF stimulation for sympathetic electrical storm is ongoing.…”

Section: Other Regulation Methodsmentioning

confidence: 99%

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

Xiong

et al. 2021

Front. Cardiovasc. Med.

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Sympathetic overactivation plays an important role in promoting a variety of pathophysiological processes in cardiovascular diseases (CVDs), including ventricular remodeling, vascular endothelial injury and atherosclerotic plaque progression. Device-based sympathetic nerve (SN) regulation offers a new therapeutic option for some CVDs. Renal denervation (RDN) is the most well-documented method of device-based SN regulation in clinical studies, and several large-scale randomized controlled trials have confirmed its value in patients with resistant hypertension, and some studies have also found RDN to be effective in the control of heart failure and arrhythmias. Pulmonary artery denervation (PADN) has been clinically shown to be effective in controlling pulmonary hypertension. Hepatic artery denervation (HADN) and splenic artery denervation (SADN) are relatively novel approaches that hold promise for a role in cardiovascular metabolic and inflammatory-immune related diseases, and their first-in-man studies are ongoing. In addition, baroreflex activation, spinal cord stimulation and other device-based therapies also show favorable outcomes. This review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for some CVDs.

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Section: Other Regulation Methodsmentioning

confidence: 99%

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

Xiong

et al. 2021

Front. Cardiovasc. Med.

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“…They showed that this strategy significantly decreased left stellate ganglion activity and reduced myocardial infarction-induced ventricular arrhythmia burden. Markman et al [187] published a case series on five patients suffering from ventricular tachycardia storm (≥ 3 episodes of sustained ventricular tachycardia in 24 h), which were all treated with transcutaneous magnetic stimulation of the left stellate ganglion. This strategy successfully lowered arrhythmia burden and was not associated with any adverse events, further highlighting the potential of this modality to serve as a bridge to more permanent interventions.…”

Section: Emerging Modalities Of Neural Modulationmentioning

confidence: 99%

“…Also in the setting of recurrent ventricular arrhythmias, inflammatory processes were active in stellate ganglia, which might imply that microglia and other inflammatory cells contribute to this pathological phenotype. Though the role of microglia in ventricular arrhythmogenesis has been scarcely studied, Wang et al 187 [ 97 ] used a post-infarct murine model to demonstrate their involvement in ventricular arrhythmogenesis. In their study, microglial activation was inhibited through light-emitting diode (LED) illumination, a fairly new non-thermal method that modulates cellular activity through photons that are absorbed by mitochondrial chromophores [ 98 ].…”

Section: Interventionsmentioning

confidence: 99%

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Autonomic modulation of ventricular electrical activity: recent developments and clinical implications

2021

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Purpose This review aimed to provide a complete overview of the current stance and recent developments in antiarrhythmic neuromodulatory interventions, focusing on lifethreatening vetricular arrhythmias. Methods Both preclinical studies and clinical studies were assessed to highlight the gaps in knowledge that remain to be answered and the necessary steps required to properly translate these strategies to the clinical setting. Results Cardiac autonomic imbalance, characterized by chronic sympathoexcitation and parasympathetic withdrawal, destabilizes cardiac electrophysiology and promotes ventricular arrhythmogenesis. Therefore, neuromodulatory interventions that target the sympatho-vagal imbalance have emerged as promising antiarrhythmic strategies. These strategies are aimed at different parts of the cardiac neuraxis and directly or indirectly restore cardiac autonomic tone. These interventions include pharmacological blockade of sympathetic neurotransmitters and neuropeptides, cardiac sympathetic denervation, thoracic epidural anesthesia, and spinal cord and vagal nerve stimulation. Conclusion Neuromodulatory strategies have repeatedly been demonstrated to be highly effective and very promising anti-arrhythmic therapies. Nevertheless, there is still much room to gain in our understanding of neurocardiac physiology, refining the current neuromodulatory strategic options and elucidating the chronic effects of many of these strategic options.

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“…Magnetic stimulation has been shown to modify arrhythmia risk by targeting cardiac sympathetic innervation in animal models . We had previously performed a feasibility study of TcMS in patients with VT storm, which demonstrated a lower burden of VT with no adverse events . This double-blind, randomized pilot study was conducted to characterize the effects of a single session of TcMS for patients with VT storm.…”

Section: Introductionmentioning

confidence: 99%

Effect of Transcutaneous Magnetic Stimulation in Patients With Ventricular Tachycardia Storm

et al. 2022

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IMPORTANCE Autonomic neuromodulation provides therapeutic benefit in ventricular tachycardia (VT) storm. Transcutaneous magnetic stimulation (TcMS) can noninvasively and nondestructively modulate a patient's nervous system activity and may reduce VT burden in patients with VT storm. OBJECTIVE To evaluate the safety and efficacy of TcMS of the left stellate ganglion for patients with VT storm. DESIGN, SETTING, AND PARTICIPANTS This double-blind, sham-controlled randomized clinical trial took place at a single tertiary referral center between August 2019 and July 2021. The study included 26 adult patients with 3 or more episodes of VT in 24 hours. INTERVENTIONS Patients were randomly assigned to receive a single session of either TcMS that targeted the left stellate ganglion (n = 14) or sham stimulation (n = 12). MAIN OUTCOMES AND MEASURESThe primary outcome was freedom from VT in the 24-hour period following randomization. Key secondary outcomes included safety of TcMS on cardiac implantable electronic devices, as well as burden of VT in the 72-hour period following randomization.RESULTS Among 26 patients (mean [SD] age, 64 [13] years; 20 [77%] male), a mean (SD) of 12.7 (10.3) episodes of VT occurred within the 24 hours preceding randomization. Patients had recurrent VT despite taking a mean (SD) of 2.0 (0.6) antiarrhythmic drugs (AADs), and 11 patients (42%) required mechanical hemodynamic support at the time of randomization. In the 24-hour period after randomization, VT recurred in 4 of 14 patients (29% [SD 47%]) in the TcMS group vs 7 of 12 patients (58% [SD 51%]) in the sham group (P = .20). In the 72-hour period after randomization, patients in the TcMS group had a mean (SD) of 4.5 (7.2) episodes of VT vs 10.7 (13.8) in the sham group (incidence rate ratio, 0.42; P < .001). Patients in the TcMS group were taking fewer AADs 24 hours after randomization compared with baseline (mean [SD], 0.9 [0.8] vs 1.8 [0.4]; P = .001), whereas there was no difference in the number of AADs taken for the sham group (mean [SD], 2.3 [0.8] vs 1.9 [0.5]; P = .20). None of the 7 patients in the TcMS group with a cardiac implantable electronic device had clinically significant effects on device function. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, findings support the potential for TcMS to safely reduce the burden of VT in the setting of VT storm in patients with and without cardiac implantable electronic devices and inform the design of future trials to further investigate this novel treatment approach.

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Case Series of Transcutaneous Magnetic Stimulation for Ventricular Tachycardia Storm

Cited by 15 publications

References 11 publications

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

Autonomic modulation of ventricular electrical activity: recent developments and clinical implications

Effect of Transcutaneous Magnetic Stimulation in Patients With Ventricular Tachycardia Storm

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