Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias.
Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias.
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DOI：
10.1016/j.jacc.2017.04.035
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发表时间：
2017-06-27
影响因子：
24
通讯作者：
Shivkumar K
中科院分区：
文献类型：
--
作者：
Vaseghi M;Barwad P;Malavassi Corrales FJ;Tandri H;Mathuria N;Shah R;Sorg JM;Gima J;Mandal K;Sàenz Morales LC;Lokhandwala Y;Shivkumar K
心脏交感神经切除术（CSD）已被证明可以减少一小部分结构性心脏病（SHD）和复发性室性快速性心律失常（VT）患者的植入式心律转复除颤器（ICD）电击负担。我们评估了CSD的价值以及与该人群结局相关的特征。国际心脏交感神经去神经协作组对5个国际中心接受CSD治疗难治性VT或VT风暴的SHD患者进行了分析。Kaplan-Meier分析用于估计无ICD休克、移植和死亡。采用考克斯比例风险模型分析与CSD后ICD休克复发和死亡率相关的变量。2009年至2016年，121例患者（年龄55 ± 13岁，26%为女性，射血分数30 ± 13%）接受了左侧或双侧CSD。1年无持续性VT/ICD休克和ICD无休克生存率分别为58.2%和50.4%。CSD将ICD电击的负担从进入研究前一年的平均18 ± 30（中位数10）降低到中位随访1.1年时的2.0 ± 4.3（中位数0）（p < 0.01）。在多变量分析中，术前纽约心脏协会（NYHA）III级和IV级心力衰竭和较长的VT周期长度与ICD电击复发相关，而高级NYHA分级、较长的VT周期长度和仅左侧手术预测了持续性VT/ICD电击复发、死亡和移植的联合终点。在CSD前服用抗抑郁药的120例患者中，39例（32%）在随访时不再需要这些药物。CSD降低了难治性VT患者的持续性VT和ICD电击复发率。与复发和死亡率独立相关的特征是晚期心力衰竭、VT周期长度和仅左侧手术。
Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in a small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT). We assessed the value of CSD and the characteristics associated with outcomes in this population. Patients with SHD who underwent CSD for refractory VT or VT storm in 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD. Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, and an ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock-free survival were 58.2% and 50.4%, respectively. CSD reduced burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year prior to 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 (NYHA) class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, while advanced NYHA 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 on antiarrhythmic medication prior to CSD, 39 (32%) no longer required them at follow-up. CSD 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.
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DOI：
10.1056/nejmoa071098
发表时间：
2008-09-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
Poole JE;Johnson GW;Hellkamp AS;Anderson J;Callans DJ;Raitt MH;Reddy RK;Marchlinski FE;Yee R;Guarnieri T;Talajic M;Wilber DJ;Fishbein DP;Packer DL;Mark DB;Lee KL;Bardy GH
通讯作者：
Bardy GH
影响因子：
2.4
作者：
Ramsaroop, L;Partab, P;Satyapal, KS
通讯作者：
Satyapal, KS
影响因子：
37.8
作者：
Lopshire, John C.;Zhou, Xiaohong;Zipes, Douglas P.
通讯作者：
Zipes, Douglas P.
DOI：
10.1111/j.1540-8159.1997.tb04817.x
发表时间：
1997-01-01
影响因子：
1.8
作者：
Herrmann, C;vonzurMuhen, F;Gonska, BD
通讯作者：
Gonska, BD
影响因子：
2.1
作者：
ARMOUR, JA
通讯作者：
ARMOUR, JA