Long-term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias
Long-term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias
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DOI：
10.1111/jce.14947
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发表时间：
2021-02-25
影响因子：
2.7
通讯作者：
Lokhandwala, Yash
中科院分区：
文献类型：
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作者：
Barwad, Parag;Sinkar, Kunal;Lokhandwala, Yash
背景心脏交感神经切除术（CSD）是治疗标准抗心律失常药物（AAD）或导管消融（CA）无效的结构性心脏病（SHD）和室性心动过速（VT）患者的有效治疗选择。在这项研究中，我们试图回顾性分析CSD在难治性VT和/或VT风暴患者中的长期结局，大多数患者在CA之前接受CSD。方法我们纳入了2010年至2019年因难治性VT接受CBD的连续SHD患者。CSD的完全反应被定义为大于75%的ICD电击频率减少VT。结果共65例患者（50名男性，15名女性）。30例（46.2%）患者的基础VT底物为缺血性心脏病（IHD），其余35例（53.8%）患者有其他非缺血性原因。平均随访时间为27 +/- 24个月。47例（72.3%）患者对CSD完全缓解。CSD后植入式心律转复除颤器（ICD）或体外除颤器电击的数量显著下降（24 +/- 37 vs. 2 +/- 4，p <0.01）。2年时无ICD休克或死亡联合终点的比率为51.5%。先进的纽约心脏协会类（III和IV）是唯一的参数发现与此相关联的联合endpoint.Conclusion目前的回顾性分析再次强调的作用，外科CSD和探索其作用提前CA在治疗难治性室性心动过速或室性心动过速风暴患者。
Background Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA.Methods We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT.Results A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 +/- 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 +/- 37 vs. 2 +/- 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint.Conclusion The current retrospective analysis re-emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.