Surgical technique ‘may benefit’ patients with ventricular arrhythmia
MedWire News: Bilateral cardiac sympathetic denervation (BCSD) may be beneficial for patients with incessant ventricular arrhythmias (VAs), researchers say.
The findings suggest that for those patients with VA for whom no other therapeutic options exist, BCSD may be a viable option, write Kalyanam Shivkumar (University of California Los Angeles, USA) and colleagues in a research correspondence article published in the Journal of the American College of Cardiology.
Their study included five men and one woman with a mean age of 60.1 years and a mean left ventricular ejection fraction of 25.8%. All patients presented with electrical storm, characterized by incessant ventricular tachycardia or repeated episodes of ventricular fibrillation.
Only after failure of catheter ablation, implantable defibrillator therapy, and optimal beta-blockade treatment with metoprolol (50%), carvediol (50%), and amiodarone were the patients considered for BCSD.
During the procedure, explained Shivkumar in a press statement, the stellate ganglion, as well as the three ganglia below it, are cut. This can be carried out on the left, right, or both sides of the thorax.
After the surgery, four (66.7%) patients displayed complete response, while one (16.7%) showed partial response, and one (16.7%) showed no response.
Three of the responding patients received no more shocks from their implantable cardioverter defibrillator after the surgery, and shocks decreased by 50% in the patient who partially responded to BCSD.
Of note, one of the responding patients who had been receiving up to 11 shocks per day before the surgery received none afterwards.
All five patients who showed a reduction in VAs after BCSD survived to discharge, but two of the responding patients died after discharge due to non-arrhythmia related issues.
"Mechanisms underlying the benefit of BCSD may include the interruption of adverse stellate ganglion remodeling or the mitigation of pro-arrhythmic neural signaling within the myocardium or stellate ganglia," suggest the authors.
"In the future, we may be able to correct what is wrong with the heart early, like fixing what's broken in an airplane engine before we need a parachute like an implantable defibrillator," commented Shivkumar.
The authors acknowledge that a major limitation of their study is its small sample size and say that they plan to further analyze the effects of BCSD in a larger patient population.
By Piriya Mahendra