Marmar Vaseghi1, Parag Barwad2, Federico J Malavassi Corrales3, Harikrishna Tandri4, Nilesh Mathuria5, Rushil Shah2, Julie M Sorg6, Jean Gima6, Kaushik Mandal4, Luis C Sàenz Morales3, Yash Lokhandwala2, Kalyanam Shivkumar7. 1. UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California; Neurocardiology Research Center of Excellence at UCLA, Los Angeles, California. Electronic address: mvaseghi@mednet.ucla.edu. 2. Holy Family Heart Institute, Holy Family Hospital, Mumbai, India. 3. Centro Internacional de Arritmias, Fundacion Cardio Infantil-Instituto de Cardiologia, Bogota, Colombia. 4. Johns Hopkins Heart and Vascular Institute, Johns Hopkins University, Baltimore, Maryland. 5. Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas. 6. UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California. 7. UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California; Neurocardiology Research Center of Excellence at UCLA, Los Angeles, California.
Abstract
BACKGROUND: Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT). OBJECTIVES: This study assessed the value of CSD and the characteristics associated with outcomes in this population. METHODS: Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD. RESULTS: Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p < 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up. CONCLUSIONS: CSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.
BACKGROUND: Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT). OBJECTIVES: This study assessed the value of CSD and the characteristics associated with outcomes in this population. METHODS:Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD. RESULTS: Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p < 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up. CONCLUSIONS: CSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.
Authors: Justin Hayase; Veronica Dusi; Duc Do; Olujimi A Ajijola; Marmar Vaseghi; Jay M Lee; Jane Yanagawa; Nir Hoftman; Sha'Shonda Revels; Eric F Buch; Houman Khakpour; Osamu Fujimura; Yuliya Krokhaleva; Carlos Macias; Julie Sorg; Jean Gima; Geraldine Pavez; Noel G Boyle; Kalyanam Shivkumar; Jason S Bradfield Journal: J Cardiovasc Electrophysiol Date: 2020-06-30
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