Prognostic impact of atrial rhythm and dimension in patients with structural heart disease undergoing cardiac sympathetic denervation for ventricular arrhythmias
| Autor: | Jay M. Lee, Jean Gima, Veronica Dusi, Kalyanam Shivkumar, Julie M. Sorg, Jason S. Bradfield, Marmar Vaseghi, Gaetano M. De Ferrari, Jeffrey Gornbein, Jane Yanagawa, Olujimi A. Ajijola, Natalia Vecerek |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Cardiac sympathetic denervation Heart disease Cardiorespiratory Medicine and Haematology 030204 cardiovascular system & hematology Cardiovascular 0302 clinical medicine Heart Rate Interquartile range Tachycardia Medicine 030212 general & internal medicine Structural heart disease Ejection fraction Atrial arrhythmias Middle Aged Prognosis Atrial Function Treatment Outcome Heart Disease Echocardiography Shock (circulatory) Cardiology Female medicine.symptom Cardiology and Cardiovascular Medicine medicine.medical_specialty Autonomic nervous system Left atrial volume index Biomedical Engineering Article 03 medical and health sciences Rhythm Refractory Heart Conduction System Clinical Research Physiology (medical) Internal medicine Humans In patient Heart Atria Sympathectomy Retrospective Studies business.industry Ventricular Stroke Volume medicine.disease Cardiovascular System & Hematology Tachycardia Ventricular business Follow-Up Studies |
| Zdroj: | Heart rhythm, vol 17, iss 5 Pt A Heart Rhythm |
| Popis: | BackgroundCardiac sympathetic denervation (CSD) is a promising treatment for patients with structural heart disease (SHD) and refractory ventricular tachyarrhythmias (VTs). The effect of CSD on atrial rhythm as well as the prognostic impact of atrial arrhythmias (AAs) or left atrial volume index (LAVI) on CSD outcome are unknown.ObjectivesThe goals of this study were to evaluate the impact of AAs and LAVI on CSD outcome and to assess changes in AAs burden and in atrial pacing after CSD.MethodsPatients with SHD undergoing CSD for VTs were analyzed. Hazards models were built to assess predictors of sustained VT/implantable cardioverter-defibrillator (ICD) shock recurrences and death/orthotopic heart transplant (OHT). Changes before vs after CSD were assessed using ICD, clinical, and echocardiographic data. A drug index was devised to correct for medication use.ResultsBetween 2009 and 2018, 91 patients (mean age 56 ± 13 years; mean left ventricular ejection fraction 34% ± 14%; 47% with a history of AAs) underwent left CSD (16%) or bilateral CSD (BCSD). The median follow-up was 14 months (interquartile range 4-37 months). Using multivariable analysis, neither LAVI nor AAs were associated with recurrences; LAVI was an independent predictor of death/OHT. AAs burden did not change after BCSD, but atrial pacing increased from a median of 28% to 72% (P < .01). Left ventricular end-diastolic diameter slightly increased; however, sustained VT/ICD shocks were reduced.ConclusionIn patients with SHD undergoing CSD, LAVI predicts death/OHT. AAs burden, already low at baseline, was unchanged after BCSD, while the need for atrial pacing increased, suggesting an impact of BCSD on sinus node chronotropism. |
| Databáze: | OpenAIRE |
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