Cheng Cai1,2, Ming-Yan Dai2,3, Ying Tian2,4, Pei Zhang2,5, Erica D Wittwer6, Richard H Rho6, Suraj Kapa2, Christopher J McLeod7, Siva K Mulpuru2, Hon-Chi Lee2, Michael J Ackerman2, Samuel J Asirvatham2, Thomas M Munger2, Ming-Long Chen1, Paul A Friedman2, Yong-Mei Cha2. 1. Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota. 3. Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China. 4. Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, Beijing, China. 5. Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China. 6. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota. 7. Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida.
Abstract
INTRODUCTION: Autonomic modulation has been used as a therapy to control recurrent ventricular arrhythmia (VA). This study was to explore stellate ganglion block (SGB) effect on cardiac electrophysiologic properties and evaluate the long-term outcome of cardiac sympathetic denervation (CSD) for patients with recurrent VA and structural heart disease (SHD). MATERIALS AND METHODS: Patients who had recurrent VA due to SHD were enrolled prospectively. Electrophysiologic study and ventricular tachycardia (VT) induction were performed before and after left and right SGB. VA burden and long-term outcomes were assessed for a separate patient group who underwent left or bilateral CSD for drug-refractory VA due to SHD. RESULTS: Electrophysiologic study of nine patients showed that baseline mean (SD) corrected sinus node recovery time (cSNRT) increased from 320.4 (73.3) ms to 402.9 (114.2) ms after left and 482.4 (95.7) ms after bilateral SGB (P = .03). SGB did not significantly change P-R, QRS, and Q-T intervals and ventricular effective refractory period, nor did the inducibility of VA. Nineteen patients underwent left (n = 14) or bilateral (n = 5) CSD. CSD reduced VA burden and appropriate ICD therapies from a median (interquartile range) of 2.5 (0.4-11.6) episodes weekly to 0.1 (0.0-2.4) episodes weekly at 6-month follow-up (P = .002). Three-year freedom from orthotopic heart transplant (OHT) and death was 52.6%. New York Heart Association functional class III/IV and VT rate less than 160 beats per minute were predictors of recurrent VA, OHT, and death. CONCLUSION: SGB increased cSNRT without changing heart rate. CSD was more beneficial for patients with mild-to-moderate heart failure and faster VA.
INTRODUCTION: Autonomic modulation has been used as a therapy to control recurrent ventricular arrhythmia (VA). This study was to explore stellate ganglion block (SGB) effect on cardiac electrophysiologic properties and evaluate the long-term outcome of cardiac sympathetic denervation (CSD) for patients with recurrent VA and structural heart disease (SHD). MATERIALS AND METHODS:Patients who had recurrent VA due to SHD were enrolled prospectively. Electrophysiologic study and ventricular tachycardia (VT) induction were performed before and after left and right SGB. VA burden and long-term outcomes were assessed for a separate patient group who underwent left or bilateral CSD for drug-refractory VA due to SHD. RESULTS: Electrophysiologic study of nine patients showed that baseline mean (SD) corrected sinus node recovery time (cSNRT) increased from 320.4 (73.3) ms to 402.9 (114.2) ms after left and 482.4 (95.7) ms after bilateral SGB (P = .03). SGB did not significantly change P-R, QRS, and Q-T intervals and ventricular effective refractory period, nor did the inducibility of VA. Nineteen patients underwent left (n = 14) or bilateral (n = 5) CSD. CSD reduced VA burden and appropriate ICD therapies from a median (interquartile range) of 2.5 (0.4-11.6) episodes weekly to 0.1 (0.0-2.4) episodes weekly at 6-month follow-up (P = .002). Three-year freedom from orthotopic heart transplant (OHT) and death was 52.6%. New York Heart Association functional class III/IV and VT rate less than 160 beats per minute were predictors of recurrent VA, OHT, and death. CONCLUSION: SGB increased cSNRT without changing heart rate. CSD was more beneficial for patients with mild-to-moderate heart failure and faster VA.
Authors: Veronica Dusi; Julie M Sorg; Jeffrey Gornbein; Jean Gima; Jane Yanagawa; Jay M Lee; Natalia Vecerek; Marmar Vaseghi; Jason S Bradfield; Gaetano M De Ferrari; Kalyanam Shivkumar; Olujimi A Ajijola Journal: Heart Rhythm Date: 2019-12-16 Impact factor: 6.343
Authors: Veronica Dusi; Jeffrey Gornbein; Duc H Do; Julie M Sorg; Houman Khakpour; Yuliya Krokhaleva; Olujimi A Ajijola; Carlos Macias; Jason S Bradfield; Eric Buch; Osamu A Fujimura; Noel G Boyle; Jane Yanagawa; Jay M Lee; Kalyanam Shivkumar; Marmar Vaseghi Journal: J Am Heart Assoc Date: 2021-01-14 Impact factor: 5.501