| Neuraxial modulation for refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation. | |
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MedLine Citation:
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PMID: 20479150 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structural heart disease. METHODS AND RESULTS: Clinical data of 14 patients (25 to 75 years old, mean+/-SD of 54.2+/-16.6 years; 13 men) who underwent TEA, LCSD, or both to control ventricular tachycardia (VT) refractory to medical therapy and catheter ablation were reviewed. Twelve patients were in VT storm, and 2 experienced recurrent VT despite maximal medical therapy and catheter ablation procedures. The total number of therapies per patient before either procedure ranged from 5 to 202 (median of 24; 25th and 75th percentile, 5 and 56). Eight patients underwent TEA, and 9 underwent LCSD (3 patients had both procedures). No major procedural complications occurred. After initiation of TEA, 6 patients had a large (> or =80%) decrease in VT burden. After LCSD, 3 patients had no further VT, 2 had recurrent VT that either resolved within 24 hours or responded to catheter ablation, and 4 continued to have recurrent VT. Nine of 14 patients survived to hospital discharge (2 TEA alone, 3 TEA/LCSD combined, and 4 LCSD alone), 1 of the TEA alone patients underwent an urgent cardiac transplantation. CONCLUSIONS: Initiation of TEA and LCSD in patients with refractory VT was associated with a subsequent decrease in arrhythmia burden in 6 (75%) of 8 patients (68% confidence interval 51% to 91%) and 5 (56%) of 9 patients (68% confidence interval 34% to 75%), respectively. These data suggest that TEA and LCSD may be effective additions to the management of refractory ventricular arrhythmias in structural heart disease when other treatment modalities have failed or may serve as a bridge to more definitive therapy. |
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Authors:
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Tara Bourke; Marmar Vaseghi; Yoav Michowitz; Vineet Sankhla; Mandar Shah; Nalla Swapna; Noel G Boyle; Aman Mahajan; Calambur Narasimhan; Yash Lokhandwala; Kalyanam Shivkumar |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural Date: 2010-05-17 |
Journal Detail:
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Title: Circulation Volume: 121 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-02 Completed Date: 2010-06-21 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2255-62 Citation Subset: AIM; IM |
Affiliation:
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UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anesthesia, Epidural / methods* Catheter Ablation Female Follow-Up Studies Humans Male Middle Aged Retrospective Studies Sympathectomy / methods* Tachycardia, Ventricular / physiopathology, therapy* Thoracic Surgery, Video-Assisted / methods Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL084261-05/HL/NHLBI NIH HHS; R01HL084261/HL/NHLBI NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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