Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes.
Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes.
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DOI：
10.1111/jce.14624
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发表时间：
2020-09
影响因子：
2.7
通讯作者：
Bradfield JS
中科院分区：
文献类型：
--
作者：
Hayase J;Dusi V;Do D;Ajijola OA;Vaseghi M;Lee JM;Yanagawa J;Hoftman N;Revels S;Buch EF;Khakpour H;Fujimura O;Krokhaleva Y;Macias C;Sorg J;Gima J;Pavez G;Boyle NG;Shivkumar K;Bradfield JS
当射频消融（RFA）难治或患者/室性心动过速特征不利于RFA时，心脏交感神经去神经支配（CSD）用于管理结构性心脏病的室性心动过速（VT）我们研究了2009-2018年在我们机构接受CSD的连续患者，CSD后VT需要重复RFA。评估了患者人口统计学、VT/手术特征和结局。96例患者患有CSD，16例患者因CSD后VT接受了RFA。15例男性和1例女性患者，平均年龄54.2±13.2岁。14例患者有非缺血性心肌病。在患者接受CSD之前，平均2.0±0.8次室性心动过速射频消融失败。CSD和RFA之间的中位时间为104天（IQR=15-241）。CSD后的临床VT周期长度在ECG和/或ICD询问时自发（CSD前355± 73 ms vs CSD后422± 94 ms，p=0.001）和术中（CSD前406± 86 ms vs CSD后457± 88 ms，p=0.03）均显著增加。CSD前有2例多形性VT，14例单形性VT（MMVT），CSD后所有患者均发生MMVT。可标测的血流动力学稳定VT的比例从CSD RFA前的35%增加到CSD RFA后的58%（p=0.038）。在RFA后中位随访413天（IQR=43-1840）时，8例患者没有进一步的VT。CSD后复发性MMVT的RFA是一种合理的治疗选择，在50%的患者中获得了中期临床成功。CSD后临床室性心动过速周期长度显著增加，射频消融期间可标测的血流动力学耐受室性心动过速也相应改善。
Cardiac sympathetic denervation (CSD) is utilized for management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA We studied consecutive patients who underwent CSD at our institution from 2009-2018 with VT requiring repeat RFA post-CSD. Patient demographics, VT/procedural characteristics and outcomes were assessed. Ninety-six patients had CSD, 16 patients underwent RFA for VT post-CSD. There were 15 male and 1 female patients with mean age 54.2±13.2 years. Fourteen patients had nonischemic cardiomyopathy. A mean of 2.0±0.8 RFAs for VT were unsuccessful prior to the patient undergoing CSD. The median time between CSD and RFA was 104 days (IQR=15-241). The clinical VT cycle length was significantly increased after CSD both spontaneously on ECG and/or ICD interrogation (355±73ms pre-CSD versus 422±94ms post-CSD, p=0.001) and intraprocedurally (406±86ms pre-CSD versus 457±88ms post-CSD, p=0.03). Two patients had polymorphic and fourteen had monomorphic VT (MMVT) pre-CSD, and all patients had MMVT post-CSD. The proportion of mappable, hemodynamically stable VTs increased from 35% during pre-CSD RFA to 58% during post-CSD RFA (p=0.038). At median follow-up of 413 days (IQR=43-1840) after RFA, eight patients had no further VT. RFA for recurrent MMVT post-CSD is a reasonable treatment option with intermediate-term clinical success in 50% of patients. Clinical VT cycle length was significantly increased after CSD with associated improvement in mappable, hemodynamically tolerated VT during RFA.
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影响因子：
5.5
作者：
Tung R;Vaseghi M;Frankel DS;Vergara P;Di Biase L;Nagashima K;Yu R;Vangala S;Tseng CH;Choi EK;Khurshid S;Patel M;Mathuria N;Nakahara S;Tzou WS;Sauer WH;Vakil K;Tedrow U;Burkhardt JD;Tholakanahalli VN;Saliaris A;Dickfeld T;Weiss JP;Bunch TJ;Reddy M;Kanmanthareddy A;Callans DJ;Lakkireddy D;Natale A;Marchlinski F;Stevenson WG;Della Bella P;Shivkumar K
通讯作者：
Shivkumar K
影响因子：
24
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
通讯作者：
Shivkumar K
DOI：
10.1152/ajpheart.00575.2016
发表时间：
2017-03-01
影响因子：
4.8
作者：
Ajijola, Olujimi A.;Lux, Robert L.;Shivkumar, Kalyanam
通讯作者：
Shivkumar, Kalyanam
影响因子：
7
作者：
Vaseghi, Marmar;Hu, Tiffany Y.;Shivkumar, Kalyanam
通讯作者：
Shivkumar, Kalyanam
DOI：
10.1152/ajpheart.00434.2013
发表时间：
2013-10-01
影响因子：
4.8
作者：
Ajijola, Olujimi A.;Yagishita, Daigo;Shivkumar, Kalyanam
通讯作者：
Shivkumar, Kalyanam