Abstract:Background: Cardiac sympathetic denervation (CSD) is being used in the management of refractory ventricular tachycardia (VT) and electrical storm. However, data on the role of CSD in the management of ventricular arrhythmia is limited. Methods: We performed a meta-analysis of retrospective studies to calculate the pooled rate of freedom from VT and the standard mean difference of ICD shocks before and after CSD. Results: 14 nonrandomized studies with a total of 311 patients with refractory VT or electrical sto… Show more
“…The authors concluded patients with NICM are more challenging for catheter ablation and would be the target population for CSD. A recent meta-analysis included 311 patients who underwent CSD for refractory VT or electrical storm and found a 60% rate of freedom from VT at a mean follow-up of 15 months ( 10 ). Figure 2 Mechanism of Bilateral Cardiac Sympathetic Denervation in Reduction of Ventricular Arrhythmias The lower one half of the stellate ganglion and the thoracic ganglia at T1 to T4 was transected bilaterally, interrupting the sympathetic input to the heart and reducing ventricular tachycardia recurrence.…”
Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (
Level of Difficulty: Advanced.
)
“…The authors concluded patients with NICM are more challenging for catheter ablation and would be the target population for CSD. A recent meta-analysis included 311 patients who underwent CSD for refractory VT or electrical storm and found a 60% rate of freedom from VT at a mean follow-up of 15 months ( 10 ). Figure 2 Mechanism of Bilateral Cardiac Sympathetic Denervation in Reduction of Ventricular Arrhythmias The lower one half of the stellate ganglion and the thoracic ganglia at T1 to T4 was transected bilaterally, interrupting the sympathetic input to the heart and reducing ventricular tachycardia recurrence.…”
Cardiac sympathetic denervation has been shown to reduce sustained ventricular arrhythmias and implantable cardioverter-defibrillator shocks by inhibiting sympathetic outflow to the heart. We describe the first case to our knowledge of cardiac sympathetic denervation in the left ventricular assist device population. (
Level of Difficulty: Advanced.
)
“…Even though this strategy is still highly restricted to a few “expertise centers,” the number and size of clinical studies is ever expanding. The success of this treatment modality was reconfirmed in a meta-analysis by Murtaza et al [ 101 ] which combined the results of 14 retrospective clinical studies that included a total of 311 patients with recurrent ventricular tachycardia or electrical storm. Their analyses showed that CSD resulted in complete abolishment of ventricular tachycardia in approximately 60% of treated patients (average follow-up time: 15 ± 10.7 months) and a significant decrease of 3.01 in mean implantable cardioverter-defibrillator (ICD) shocks [ 101 ].…”
Section: Interventionsmentioning
confidence: 98%
“…The success of this treatment modality was reconfirmed in a meta-analysis by Murtaza et al [ 101 ] which combined the results of 14 retrospective clinical studies that included a total of 311 patients with recurrent ventricular tachycardia or electrical storm. Their analyses showed that CSD resulted in complete abolishment of ventricular tachycardia in approximately 60% of treated patients (average follow-up time: 15 ± 10.7 months) and a significant decrease of 3.01 in mean implantable cardioverter-defibrillator (ICD) shocks [ 101 ]. Importantly, these results of CSD efficacy are similar between patients with and without an ischemic substrate underlying their ventricular arrhythmias [ 102 , 103 ].…”
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.
“… 59 Modulation of the autonomic nervous system and neuraxial blockade are important therapies for electrical storm 60 and are an established component of antiarrhythmic therapy for specific genetic syndromes, including long QT syndrome. 61 Emerging data suggest that autonomic modulation may be an effective tool in the broader population of secondary prevention patients, 62 though more data are needed.…”
Section: Novel Strategies For Arrhythmia Risk Reductionmentioning
The prevention and treatment of sudden cardiac death (SCD) remains a significant public health challenge. For patients with a history of sudden death attributable to ventricular arrhythmia, implantable cardioverter-defibrillator (ICD) therapy is a mainstay of treatment, although these patients remain at high risk for recurrent ventricular arrhythmia and defibrillator therapies. In this review, we summarize landmark clinical trials evaluating the efficacy of ICD therapy in secondary prevention patients, review clinical outcomes including mode of death in survivors of SCD, and highlight the role for systematic diagnostic evaluation. We additionally discuss the invasive electrophysiological management of these patients, including ICD selection and programming as well as the role and timing of antiarrhythmic drug therapy and catheter ablation. Finally, we frame future challenges and needs to advance the care for secondary prevention patients.
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