Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias
| Autor: | Harikrishna Tandri, Marmar Vaseghi, Rushil Shah, Kalyanam Shivkumar, Julie M. Sorg, Kaushik Mandal, Yash Lokhandwala, Federico Malavassi Corrales, Jean Gima, Nilesh Mathuria, Parag Barwad, Luis C. Saenz Morales |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cardiorespiratory Medicine and Haematology 030204 cardiovascular system & hematology Cardiovascular functional class Sympathetic Denervation 03 medical and health sciences implantable cardioverter-defibrillator 0302 clinical medicine Refractory Heart Conduction System Heart Rate antiarrhythmic drugs Clinical Research Tachycardia Internal medicine otorhinolaryngologic diseases medicine Humans Sympathectomy Retrospective Studies business.industry autonomic nervous system Ventricular Middle Aged Implantable cardioverter-defibrillator Autonomic nervous system Treatment Outcome Heart Disease Cardiovascular System & Hematology Tachycardia Ventricular Public Health and Health Services Cardiology Female orthotopic heart transplantation Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology, vol 69, iss 25 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2017.04.035 |
| Popis: | BackgroundCardiac 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).ObjectivesThis study assessed the value of CSD and the characteristics associated with outcomes in this population.MethodsPatients 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 estimatefreedom 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.ResultsBetween 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.ConclusionsCSD 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. |
| Databáze: | OpenAIRE |
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