Left Cardiac Sympathetic Denervation in Long QT Syndrome

Bos, J. Martijn; Bos, Katy M.; Johnson, Jonathan N.; Moir, Christopher R.; Ackerman, Michael J.

doi:10.1161/circep.113.000102

Cited by 103 publications

(72 citation statements)

References 23 publications

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“…Several centers have reported their experience with LCSD for LQTS and CPVT. [11][12][13][14][15][16] The rate of side effects in these studies is not as high as the current authors report. However, prevention of arrhythmia is not the only indication for sympathetic denervation.…”

Section: Article See P 1151contrasting

confidence: 51%

Left Cardiac Sympathetic Denervation

Webster

Mongé

2015

Circ: Arrhythmia and Electrophysiology

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Section: Article See P 1151contrasting

confidence: 51%

Left Cardiac Sympathetic Denervation

Webster

Mongé

2015

Circ: Arrhythmia and Electrophysiology

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“…They proposed that LCSD should be considered for patients with recurrent syncope episodes under maximal pharmacological treatment and for patients who suffer arrhythmia storms in the presence of an ICD. More studies have emerged following that paper, but in the majority of them some 20 to 50% of the patients do remain symptomatic having had LCSD (15)(16)(17)(18)(19)(20)(21)(22) and there are also studies that identified that almost 50% of high-risk patients may experience more than one cardiac event post LCSD (14,20). Atallah et al (17) described that four patients with LQTS underwent VATS LCSD.…”

Section: Mini-reviewmentioning

confidence: 99%

The role of sympathectomy in long QT syndrome

et al. 2017

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“…Indeed, it is both, a safe and effective treatment option to reduce life-threatening ventricular arrhythmias in patients with heritable channelopathies such as LQTS. A prophylactic LCSD, rather than a prophylactic ICD, may represent a good treatment option for patients with unacceptable b-blocker-related side effects [41]. In contrast, a stellate ganglion blockade on the right side significantly prolongs the QT interval while the QT dispersion increases.…”

Section: The Effect Of Regional Anaesthesia Techniques On the Period mentioning

confidence: 99%

The influence of regional anaesthesia and local anaesthetics on cardiac repolarization

Biernawska

Kaźmierczak

Kotfis

et al. 2016

Anaesthesiol Intensive Ther

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The normal function of the heart muscle is the result of electro-mechanic and hemodynamic coupling. Modification of the structure and activity of ion channels within the cardiomyocytes may induce cardiac arrhythmias. Electrophysiological mechanisms of arrhythmia, generated by a prolonged period of repolarization, result either from conduction disturbances (reentry mechanism) and/or the induction of beats (early after-depolarizations). Local anaesthetic drug deposition does not affect the repolarization period, as long as the concentration of the free drug in the plasma does not reach the critical value to cause toxic effects in the cardiomyocytes. When analyzing the effect of regional anaesthesia on the repolarization period it is essential to acknowledge the activity or blockade of adrenergic fibres. Blocking the sympathetic fibres' , including level T1 to T4, leads to a shortening of the QT interval and a reduction of QT dispersion. Adrenergic blockade as a result of spinal anaesthesia causes severe adrenergic activity above the level of the block and therefore prolongs repolarization. Stellate ganglion block on the right side causes a significant prolongation of the QT interval and QT dispersion. Regardless of the reasons for prolongation of the repolarization period (congenital or acquired), vigilance is required within the perioperative anaesthetic management of a patient, so as not to lead to the occurrence of ventricular arrhythmias. Regional anaesthesia techniques and properly used local anaesthetic drugs are regarded as being safe in these patients.Key words: long QT syndromes, cardiac repolarization, regional anaesthesia, local anaesthetics Anaesthesiology Intensive Therapy 2016, vol. 48, no 2, 135-141 CARDIAC ELECTROPHYSIOLOGYNormal function of the heart muscle is the result of electro-mechanic and haemodynamic coupling. When considering cardiac electrical activity from the point of view of a working myocardial cell, the following must be acknowledged: the relaxed state (polarization of the cell membrane) and active state (depolarization-repolarization) occurring after activation by the conduction system. Changes in the phases of action potential and the resting potential are the result of a synchronized movement of ionic currents through the ion channels, pumps and cardiomyocyte cell membrane carriers. The period of depolarization is initiated by an inward sodium current (I Na ), supported by an inward calcium current (I Ca-L ). During repolarization the flow of current occurs through the channels conducting the potassium current (I Kr , I Ks , I to , I K (ATP) ) and to a lesser extent by the sodium current (I Na ), calcium current (I Ca-L ) and non-selective cation channel (I NS ). This is depicted in Figure 1.The intracellular influx of calcium ions during the plateau phase enables a calcium dependent calcium release from the sarcoplasmic reticulum, leading to a contraction of the working myocardial cell. Under such physiological conditions during repolarization, potassium I Kr and I Ks...

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Left Cardiac Sympathetic Denervation in Long QT Syndrome

Cited by 103 publications

References 23 publications

Left Cardiac Sympathetic Denervation

Left Cardiac Sympathetic Denervation

The role of sympathectomy in long QT syndrome

The influence of regional anaesthesia and local anaesthetics on cardiac repolarization

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