Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease

Cheng Cai, Ming Yan Dai, Ying Tian, Pei Zhang, Erica D. Wittwer, Richard H. Rho, Suraj Kapa, Christopher J. McLeod, Siva Mulpuru, Hon Chi Lee, Michael John Ackerman, Samuel J Asirvatham, Thomas M. Munger, Ming Long Chen, Paul Andrew Friedman, Yong-Mei Cha

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1499-1507
Number of pages9
JournalJournal of cardiovascular electrophysiology
Volume30
Issue number9
DOIs
StatePublished - Sep 1 2019

Fingerprint

Cardiac Arrhythmias
Heart Diseases
Stellate Ganglion
Sympathectomy
Sinoatrial Node
Ventricular Tachycardia
Transplants
Heart Failure
Heart Rate
Therapeutics
Pharmaceutical Preparations

Keywords

  • autonomic nervous system
  • cardiac sympathetic denervation
  • stellate ganglion block
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease. / Cai, Cheng; Dai, Ming Yan; Tian, Ying; Zhang, Pei; Wittwer, Erica D.; Rho, Richard H.; Kapa, Suraj; McLeod, Christopher J.; Mulpuru, Siva; Lee, Hon Chi; Ackerman, Michael John; Asirvatham, Samuel J; Munger, Thomas M.; Chen, Ming Long; Friedman, Paul Andrew; Cha, Yong-Mei.

In: Journal of cardiovascular electrophysiology, Vol. 30, No. 9, 01.09.2019, p. 1499-1507.

Research output: Contribution to journalArticle

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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.",
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author = "Cheng Cai and Dai, {Ming Yan} and Ying Tian and Pei Zhang and Wittwer, {Erica D.} and Rho, {Richard H.} and Suraj Kapa and McLeod, {Christopher J.} and Siva Mulpuru and Lee, {Hon Chi} and Ackerman, {Michael John} and Asirvatham, {Samuel J} and Munger, {Thomas M.} and Chen, {Ming Long} and Friedman, {Paul Andrew} and Yong-Mei Cha",
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T1 - Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease

AU - Cai, Cheng

AU - Dai, Ming Yan

AU - Tian, Ying

AU - Zhang, Pei

AU - Wittwer, Erica D.

AU - Rho, Richard H.

AU - Kapa, Suraj

AU - McLeod, Christopher J.

AU - Mulpuru, Siva

AU - Lee, Hon Chi

AU - Ackerman, Michael John

AU - Asirvatham, Samuel J

AU - Munger, Thomas M.

AU - Chen, Ming Long

AU - Friedman, Paul Andrew

AU - Cha, Yong-Mei

PY - 2019/9/1

Y1 - 2019/9/1

N2 - 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.

AB - 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.

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KW - cardiac sympathetic denervation

KW - stellate ganglion block

KW - ventricular arrhythmia

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