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Akumwami S, Morishita A, Iradukunda A, Kobara H, Nishiyama A. Possible organ-protective effects of renal denervation: insights from basic studies. Hypertens Res 2023; 46:2661-2669. [PMID: 37532952 DOI: 10.1038/s41440-023-01393-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 08/04/2023]
Abstract
Inappropriate sympathetic nervous activation is the body's response to biological stress and is thought to be involved in the development of various lifestyle-related diseases through an elevation in blood pressure. Experimental studies have shown that surgical renal denervation decreases blood pressure in hypertensive animals. Recently, minimally invasive catheter-based renal denervation has been clinically developed, which results in a reduction in blood pressure in patients with resistant hypertension. Accumulating evidence in basic studies has shown that renal denervation exerts beneficial effects on cardiovascular disease and chronic kidney disease. Interestingly, recent studies have also indicated that renal denervation improves glucose tolerance and inflammatory changes. In this review article, we summarize the evidence from animal studies to provide comprehensive insight into the organ-protective effects of renal denervation beyond changes in blood pressure.
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Affiliation(s)
- Steeve Akumwami
- Department of Anesthesiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Asahiro Morishita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | | | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan.
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Savastano S, Schwartz PJ. Blocking nerves and saving lives: Left stellate ganglion block for electrical storms. Heart Rhythm 2022:S1547-5271(22)02695-9. [PMID: 36509320 DOI: 10.1016/j.hrthm.2022.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
Patients who present with electrical storms (ES) due to rapid recurrence of ventricular tachycardia/ventricular fibrillation represent major medical emergencies without easy solutions. Antiarrhythmic drugs have limited value, and ES need to be stopped quickly to prevent irreversible patient deterioration and death. Since the mid-1970s, we have provided the rationale for interrupting cardiac sympathetic nerves and evidence of its antifibrillatory action in different clinical settings. Slowly but progressively, from isolated clinical reports to small case series, increasing evidence has indicated that pharmacologic stellate ganglion block (SGB) is highly effective in interrupting ES. However, medical guidelines have largely ignored SGB, and few centers are prepared to perform SGB in actual emergencies. Our own experience shows that a direct anatomic approach that does not require echocardiographic assistance can be performed rapidly, thus saving time in highly critical patients. In this review, we retrace the evolution in our understanding of the mechanism of action of SGB, discuss the current approaches and their limitations, and review the correct indications that overcome still existing biases. Furthermore, we propose a practical solution to increase the availability of SGB to more patients by extending the number of centers where this approach can be rapidly implemented.
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Affiliation(s)
- Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy.
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Cardiac Sympathetic Denervation for the Management of Ventricular Arrhythmias. J Interv Card Electrophysiol 2022; 65:813-826. [PMID: 35397706 DOI: 10.1007/s10840-022-01211-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The autonomic nervous system contributes to the pathogenesis of ventricular arrhythmias (VA). Though anti-arrhythmic drug therapy and catheter ablation are the mainstay of management of VAs, success may be limited in patients with more refractory arrhythmias. Sympathetic modulation is increasingly recognized as a valuable adjunct tool for managing VAs in patients with structural heart disease and inherited arrhythmias. RESULTS In this review, we explore the role of the sympathetic nervous system and rationale for cardiac sympathetic denervation (CSD) in VAs and provide a disease-focused review of the utility of CSD for patients both with and without structural heart disease. CONCLUSIONS We conclude that CSD is a reasonable therapeutic option for patients with VA, both with and without structural heart disease. Though not curative, many studies have demonstrated a significant reduction in the burden of VAs for the majority of patients undergoing the procedure. However, in patients with unilateral CSD and subsequent VA recurrence, complete bilateral CSD may provide long-lasting reprieve from VA.
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Miki Y, Yoshimura S, Sasaki T, Takizawa R, Kimura K, Haraguchi Y, Sasaki W, Kishi S, Nakatani Y, Kaseno K, Goto K, Take Y, Nakamura K, Niwamae N, Kamiyoshihara M, Naito S. Bilateral Cardiac Sympathetic Denervation for Treatment-Resistant Ventricular Arrhythmias in Heart Failure Patients with a Reduced Ejection Fraction. Int Heart J 2022; 63:692-699. [PMID: 35908853 DOI: 10.1536/ihj.21-601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The sympathetic nervous system plays an important role in life-threatening ventricular arrhythmias (VAs). Bilateral cardiac sympathetic denervation (BCSD) is performed for refractory VAs. We sought to assess our institutional experience with BCSD in managing treatment-resistant monomorphic ventricular tachycardia (MMVT) in heart failure patients with a reduced ejection fraction (HFrEF).Four patients with HFrEF (EF 30.0 ± 8.2%, New York Heart Association [NYHA] class IV 1) underwent BCSD for MMVT (VT storm 3, repetitive VT requiring implantable cardioverter defibrillator [ICD] therapy 1) refractory to antiarrhythmic drugs, catheter ablation and ICD therapy. BCSD was effective for suppressing VT in 3 patients for whom deep sedation was effective for suppressing VT. One patient remained alive after 14 months of follow-up without episodes of VT. One patient died of acute myocardial infarction before discharge and 1 patient died from unknown cause at 3 days post-discharge. In contrast, BCSD was completely ineffective for suppressing VT in a patient with NYHA class IV for whom deep sedation and stellate ganglion block were ineffective. This patient died on the 10th post-CSD day, despite left ventricular assist device implantation. In all cases, BCSD was successfully performed without procedure-related complications.Despite the limited number of cases, our results showed that BCSD in patients with HFrEF suppressed refractory MMVT in acute-phase except for a patient with NYHA class IV; however, the prognoses were not good. BCSD may be a treatment option at an earlier stage of NYHA and a bridge to orthotopic heart transplantation, even if BCSD is effective for suppressing VAs.
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Affiliation(s)
- Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Kimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | | | - Wataru Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shohei Kishi
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Koji Goto
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Nogiku Niwamae
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital
| | | | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center
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Tse R, Garland J, McCarthy S, Ondruschka B, Bardsley EN, Wong CX, Stables S, Paton JFR. Sudden cardiac deaths have higher proportion of left stellate ganglionitis. Forensic Sci Med Pathol 2022; 18:156-164. [PMID: 35349080 DOI: 10.1007/s12024-022-00466-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Abstract
One of the hypothesized mechanisms of sudden cardiac death in humans is an arrhythmia precipitated by increased sympathetic outflow to a compromised heart. The stellate ganglia provide the main sympathetic innervation to the heart, where the left stellate ganglion appears to play a role in arrhythmogenesis. Case reports of sudden cardiac death have described left stellate ganglion inflammation but no larger studies have been performed. Thus, we have specifically assessed whether the left stellate ganglion was inflamed in those dying from sudden cardiac death versus other causes of death. Thirty-one left stellate ganglia were resected from cadavers diagnosed with sudden cardiac deaths and compared with 18 ganglia from cadavers diagnosed with non-sudden cardiac deaths. Ganglia were stained with hematoxylin and eosin and lymphocytic aggregates compared. The proportion of left stellate ganglion inflammation (77%) was significantly higher in deaths from sudden cardiac deaths than non-sudden cardiac deaths (33%). This study provides information on a previously recognized, but understudied, structure that may help understand sudden cardiac death. We found high prevalence of stellate ganglion inflammation and propose that this may trigger sympathetic storms.
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Affiliation(s)
- Rexson Tse
- Northern Forensic Pathology Service of New Zealand, Auckland City Hospital, LabPLUS, Auckland, New Zealand. .,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
| | - Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia
| | - Sinead McCarthy
- Northern Forensic Pathology Service of New Zealand, Auckland City Hospital, LabPLUS, Auckland, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Emma N Bardsley
- Department of Physiology, Faculty of Medical & Health Sciences, Manaaki Mānawa, The Centre for Heart Research, University of Auckland, Auckland, New Zealand
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon Stables
- Northern Forensic Pathology Service of New Zealand, Auckland City Hospital, LabPLUS, Auckland, New Zealand.,Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Julian F R Paton
- Department of Physiology, Faculty of Medical & Health Sciences, Manaaki Mānawa, The Centre for Heart Research, University of Auckland, Auckland, New Zealand
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Stress-related dysautonomias and neurocardiology-based treatment approaches. Auton Neurosci 2022; 239:102944. [DOI: 10.1016/j.autneu.2022.102944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/13/2021] [Accepted: 01/16/2022] [Indexed: 11/21/2022]
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Safi S, Sethi NJ, Korang SK, Nielsen EE, Feinberg J, Gluud C, Jakobsen JC. Beta-blockers in patients without heart failure after myocardial infarction. Cochrane Database Syst Rev 2021; 11:CD012565. [PMID: 34739733 PMCID: PMC8570410 DOI: 10.1002/14651858.cd012565.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one cause of death globally. According to the World Health Organization (WHO), 7.4 million people died from ischaemic heart disease in 2012, constituting 15% of all deaths. Beta-blockers are recommended and are often used in patients with heart failure after acute myocardial infarction. However, it is currently unclear whether beta-blockers should be used in patients without heart failure after acute myocardial infarction. Previous meta-analyses on the topic have shown conflicting results. No previous systematic review using Cochrane methods has assessed the effects of beta-blockers in patients without heart failure after acute myocardial infarction. OBJECTIVES To assess the benefits and harms of beta-blockers compared with placebo or no treatment in patients without heart failure and with left ventricular ejection fraction (LVEF) greater than 40% in the non-acute phase after myocardial infarction. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index - Expanded, BIOSIS Citation Index, the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, European Medicines Agency, Food and Drug Administration, Turning Research Into Practice, Google Scholar, and SciSearch from their inception to February 2021. SELECTION CRITERIA We included all randomised clinical trials assessing effects of beta-blockers versus control (placebo or no treatment) in patients without heart failure after myocardial infarction, irrespective of publication type and status, date, and language. We excluded trials randomising participants with diagnosed heart failure at the time of randomisation. DATA COLLECTION AND ANALYSIS We followed our published protocol, with a few changes made, and methodological recommendations provided by Cochrane and Jakobsen and colleagues. Two review authors independently extracted data. Our primary outcomes were all-cause mortality, serious adverse events, and major cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial reinfarction). Our secondary outcomes were quality of life, angina, cardiovascular mortality, and myocardial infarction during follow-up. We assessed all outcomes at maximum follow-up. We systematically assessed risks of bias using seven bias domains and we assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We included 25 trials randomising a total of 22,423 participants (mean age 56.9 years). All trials and outcomes were at high risk of bias. In all, 24 of 25 trials included a mixed group of participants with ST-elevation myocardial infarction and non-ST myocardial infarction, and no trials provided separate results for each type of infarction. One trial included participants with only ST-elevation myocardial infarction. All trials except one included participants younger than 75 years of age. Methods used to exclude heart failure were various and were likely insufficient. A total of 21 trials used placebo, and four trials used no intervention, as the comparator. All patients received usual care; 24 of 25 trials were from the pre-reperfusion era (published from 1974 to 1999), and only one trial was from the reperfusion era (published in 2018). The certainty of evidence was moderate to low for all outcomes. Our meta-analyses show that beta-blockers compared with placebo or no intervention probably reduce the risks of all-cause mortality (risk ratio (RR) 0.81, 97.5% confidence interval (CI) 0.73 to 0.90; I² = 15%; 22,085 participants, 21 trials; moderate-certainty evidence) and myocardial reinfarction (RR 0.76, 98% CI 0.69 to 0.88; I² = 0%; 19,606 participants, 19 trials; moderate-certainty evidence). Our meta-analyses show that beta-blockers compared with placebo or no intervention may reduce the risks of major cardiovascular events (RR 0.72, 97.5% CI 0.69 to 0.84; 14,994 participants, 15 trials; low-certainty evidence) and cardiovascular mortality (RR 0.73, 98% CI 0.68 to 0.85; I² = 47%; 21,763 participants, 19 trials; low-certainty evidence). Hence, evidence seems to suggest that beta-blockers versus placebo or no treatment may result in a minimum reduction of 10% in RR for risks of all-cause mortality, major cardiovascular events, cardiovascular mortality, and myocardial infarction. However, beta-blockers compared with placebo or no intervention may not affect the risk of angina (RR 1.04, 98% CI 0.93 to 1.13; I² = 0%; 7115 participants, 5 trials; low-certainty evidence). No trials provided data on serious adverse events according to good clinical practice from the International Committee for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH-GCP), nor on quality of life. AUTHORS' CONCLUSIONS Beta-blockers probably reduce the risks of all-cause mortality and myocardial reinfarction in patients younger than 75 years of age without heart failure following acute myocardial infarction. Beta-blockers may further reduce the risks of major cardiovascular events and cardiovascular mortality compared with placebo or no intervention in patients younger than 75 years of age without heart failure following acute myocardial infarction. These effects could, however, be driven by patients with unrecognised heart failure. The effects of beta-blockers on serious adverse events, angina, and quality of life are unclear due to sparse data or no data at all. All trials and outcomes were at high risk of bias, and incomplete outcome data bias alone could account for the effect seen when major cardiovascular events, angina, and myocardial infarction are assessed. The evidence in this review is of moderate to low certainty, and the true result may depart substantially from the results presented here. Future trials should particularly focus on patients 75 years of age and older, and on assessment of serious adverse events according to ICH-GCP and quality of life. Newer randomised clinical trials at low risk of bias and at low risk of random errors are needed if the benefits and harms of beta-blockers in contemporary patients without heart failure following acute myocardial infarction are to be assessed properly. Such trials ought to be designed according to the SPIRIT statement and reported according to the CONSORT statement.
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Affiliation(s)
- Sanam Safi
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Naqash J Sethi
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joshua Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Zandstra TE, Notenboom RGE, Wink J, Kiès P, Vliegen HW, Egorova AD, Schalij MJ, De Ruiter MC, Jongbloed MRM. Asymmetry and Heterogeneity: Part and Parcel in Cardiac Autonomic Innervation and Function. Front Physiol 2021; 12:665298. [PMID: 34603069 PMCID: PMC8481575 DOI: 10.3389/fphys.2021.665298] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/26/2021] [Indexed: 11/17/2022] Open
Abstract
The cardiac autonomic nervous system (cANS) regulates cardiac adaptation to different demands. The heart is an asymmetrical organ, and in the selection of adequate treatment of cardiac diseases it may be relevant to take into account that the cANS also has sidedness as well as regional differences in anatomical, functional, and molecular characteristics. The left and right ventricles respond differently to adrenergic stimulation. Isoforms of nitric oxide synthase, which plays an important role in parasympathetic function, are also distributed asymmetrically across the heart. Treatment of cardiac disease heavily relies on affecting left-sided heart targets which are thought to apply to the right ventricle as well. Functional studies of the right ventricle have often been neglected. In addition, many principles have only been investigated in animals and not in humans. Anatomical and functional heterogeneity of the cANS in human tissue or subjects is highly valuable for understanding left- and right-sided cardiac pathology and for identifying novel treatment targets and modalities. Within this perspective, we aim to provide an overview and synthesis of anatomical and functional heterogeneity of the cANS in tissue or subjects, focusing on the human heart.
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Affiliation(s)
- Tjitske E. Zandstra
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jeroen Wink
- Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands
| | - Philippine Kiès
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Hubert W. Vliegen
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Marco C. De Ruiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
| | - Monique R. M. Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, Netherlands
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Duffy M, Garland J, Ondruschka B, Paton JFR, Bardsley EN, Wong CX, Stables S, Tse R. Stellate ganglionitis in sudden cardiac death: A case report. Auton Neurosci 2021; 234:102837. [PMID: 34182293 DOI: 10.1016/j.autneu.2021.102837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/19/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022]
Abstract
Sudden cardiac death (SCD) is the most common natural cause of death. The hypothesized mechanism of death is an arrhythmia precipitated by increased sympathetic outflow. The left stellate ganglion provides sympathetic innervation to the heart and plays a role in arrhythmogensis. We present a SCD with stellate ganglionitis in which the inflammatory cells were characterized. The case was 37-year-old man who died from ischemic and hypertensive heart disease. The left stellate ganglion showed lymphocytic inflammation with features of humoral immune response. This case report provides evidence that stellate ganglionitis can be seen in SCD and raises the possible association between the two.
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Affiliation(s)
- Michael Duffy
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand
| | - Jack Garland
- Forensic and Analytical Science Service, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian F R Paton
- Manaaki Mānawa, The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Emma N Bardsley
- Manaaki Mānawa, The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Christopher X Wong
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Simon Stables
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand; Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Rexson Tse
- Northern Forensic Pathology Service of New Zealand, Auckland, New Zealand; Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
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Abstract
BACKGROUND Meta-analyses from randomized outcome-based trials have challenged the role of beta-blockers for the treatment of hypertension. However, because they often include trials on diseases other than hypertension, the role of these drugs in the choice of the blood pressure (BP)-lowering treatment strategies remains unclear. METHODS Electronic databases were searched for randomized trials that compared beta-blockers vs. placebo/no-treatment/less-intense treatment (BP-lowering trials) or beta-blockers vs. other antihypertensive agents in patients with or without hypertension (comparison trials). Among BP-lowering trials and according to baseline comorbidity, we separately considered trials in hypertension, trials without chronic heart failure or acute myocardial infarction, and trials with either chronic heart failure or acute myocardial infarction. Seven fatal and nonfatal outcomes were calculated (random-effects model) for BP-lowering or comparison trials. RESULTS A total of 84 BP-lowering or comparison trials (165 850 patients) were eligible. In 67 BP-lowering trials (68 478 patients; mean follow-up 2.5 years; baseline SBP/DBP, 136/82 mmHg), beta blockers were associated with a lower incidence of major cardiovascular events [risk ratio 0.85 and 95% confidence interval (95% CI) 0.78-0.92] and all-cause death (risk ratio 0.81 and 95% CI 0.75-0.86). Restriction of the analysis to five trials recruiting exclusively hypertensive patients (18 724 patients; mean follow-up 5.1 years; baseline SBP/DBP 163/94 mmHg), a -10.5/-7.0 mmHg BP decrease was accompanied by reduction of major cardiovascular events by 22% (95% CI, 6-34). In 24 comparison trials (103 764 patients, 3.92 years of mean follow-up), beta-blockers compared with other agents were less protective for stroke and all-cause death in all trials and in trials conducted exclusively in hypertensive patients (averaged risk ratio increase 20 and 6%, respectively, for both cases). CONCLUSION Compared with other antihypertensive agents, beta-blockers appear to be substantially less protective against stroke and overall mortality. However, they exhibit a substantial risk-reducing ability for all events when prescribed to lower BP in patients with modest or more clear BP elevations, and therefore can be used as additional agents in hypertensive patients.
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Assis FR, Sharma A, Shah R, Akhtar T, Adari S, Calkins H, Ha JS, Mandal K, Tandri H. Long-Term Outcomes of Bilateral Cardiac Sympathetic Denervation for Refractory Ventricular Tachycardia. JACC Clin Electrophysiol 2021; 7:463-470. [PMID: 33812839 DOI: 10.1016/j.jacep.2021.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES This study sought to explore the long-term arrhythmic outcomes of bilateral cardiac sympathetic denervation (BCSD). BACKGROUND BCSD has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether BCSD antiarrhythmic effects are sustained long after the procedure is still uncertain. METHODS We included consecutive patients who underwent BCSD because of refractory ventricular tachycardia (VT) and had at least 18 months of follow-up. VT recurrence after BCSD was evaluated to assess arrhythmic outcomes. The occurrence of VT episodes within the first 12 weeks after the procedure was assessed to explore the impact of early VT recurrence on late arrhythmia-free survival. RESULTS Twenty patients (42 ± 16 years; 55% male) were included in the analysis. Nineteen (95%) patients had structural heart disease (left ventricular ejection fraction: 0.46 ± 0.14). Class I or class III drugs failed for all patients, and the mean number of VT ablation procedures was 2.5 ± 1.6. Over a mean follow-up of 1,300 ± 321 days (median: 1,276 days [Interquartile range (IQR): 1,181 to 1,480 days), 11 (55%) patients remained VT free after sympathectomy. Freedom from sustained VT or implantable cardioverter-defibrillator shock was 60% (95% confidence interval: 0.35 to 0.77) and 54.5% (95% confidence interval: 0.31 to 0.73) after BCSD at 1 and 4 years. Early VT recurrence was not associated with worse late arrhythmia-free survival rates. CONCLUSIONS BCSD was associated with longstanding antiarrhythmic effects in patients with refractory ventricular arrhythmias. The occurrence of VT episodes early after the procedure was not associated with worse late arrhythmic outcomes.
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Affiliation(s)
- Fabrizio R Assis
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rushil Shah
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tauseef Akhtar
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sushritha Adari
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jinny S Ha
- Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kaushik Mandal
- Division of Cardiothoracic Surgery, Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Raja J, Menon S, Venkata DB, Unnikrishnan KP, Namboodiri N. Congenital long QT syndrome and patent ductus arteriosus: A rare surgical scenario. Ann Pediatr Cardiol 2021; 14:85-87. [PMID: 33679068 PMCID: PMC7918017 DOI: 10.4103/apc.apc_146_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 03/25/2020] [Accepted: 07/17/2020] [Indexed: 11/04/2022] Open
Abstract
Congenital long QT syndrome (LQTS) is a rare cardiac condition characterized by abnormality of either sodium or potassium ion channels resulting in prolongation of QT interval and thereby predisposing to life-threatening arrhythmia. Once the syndrome is diagnosed, measures should be taken to avoid sudden cardiac death. We present a rare case of LQTS associated with patent ductus arteriosus in a child, and a unique approach was used in managing both conditions.
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Affiliation(s)
- Javid Raja
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiothoracic and Vascular Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Devarakonda Bhargava Venkata
- Department of Cardiac Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - KP Unnikrishnan
- Department of Cardiac Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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13
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Sáenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Europace 2020; 21:1143-1144. [PMID: 31075787 DOI: 10.1093/europace/euz132] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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14
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Tapa S, Wang L, Francis Stuart SD, Wang Z, Jiang Y, Habecker BA, Ripplinger CM. Adrenergic supersensitivity and impaired neural control of cardiac electrophysiology following regional cardiac sympathetic nerve loss. Sci Rep 2020; 10:18801. [PMID: 33139790 PMCID: PMC7608682 DOI: 10.1038/s41598-020-75903-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022] Open
Abstract
Myocardial infarction (MI) can result in sympathetic nerve loss in the infarct region. However, the contribution of hypo-innervation to electrophysiological remodeling, independent from MI-induced ischemia and fibrosis, has not been comprehensively investigated. We present a novel mouse model of regional cardiac sympathetic hypo-innervation utilizing a targeted-toxin (dopamine beta-hydroxylase antibody conjugated to saporin, DBH-Sap), and measure resulting electrophysiological and Ca2+ handling dynamics. Five days post-surgery, sympathetic nerve density was reduced in the anterior left ventricular epicardium of DBH-Sap hearts compared to control. In Langendorff-perfused hearts, there were no differences in mean action potential duration (APD80) between groups; however, isoproterenol (ISO) significantly shortened APD80 in DBH-Sap but not control hearts, resulting in a significant increase in APD80 dispersion in the DBH-Sap group. ISO also produced spontaneous diastolic Ca2+ elevation in DBH-Sap but not control hearts. In innervated hearts, sympathetic nerve stimulation (SNS) increased heart rate to a lesser degree in DBH-Sap hearts compared to control. Additionally, SNS produced APD80 prolongation in the apex of control but not DBH-Sap hearts. These results suggest that hypo-innervated hearts have regional super-sensitivity to circulating adrenergic stimulation (ISO), while having blunted responses to SNS, providing important insight into the mechanisms of arrhythmogenesis following sympathetic nerve loss.
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Affiliation(s)
- Srinivas Tapa
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Lianguo Wang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Samantha D Francis Stuart
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Zhen Wang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Yanyan Jiang
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA
| | - Beth A Habecker
- Department of Chemical Physiology and Biochemistry, Oregon Health and Science University, Portland, OR, USA
| | - Crystal M Ripplinger
- Department of Pharmacology, UC Davis School of Medicine, 2419B Tupper Hall, One Shields Ave, Davis, CA, 95616, USA.
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15
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Bella PD, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. J Interv Card Electrophysiol 2020; 59:145-298. [PMID: 31984466 PMCID: PMC7223859 DOI: 10.1007/s10840-019-00663-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, IN, USA
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, CA, USA
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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16
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Miki Y, Sasaki T, Okazaki Y, Inoue M, Niijima K, Motoda H, Take Y, Minami K, Niwamae N, Kamiyoshihara M, Nakamura K, Naito S. The effect of bilateral cardiac sympathetic denervation for refractory ventricular tachycardia in ischemic cardiomyopathy. J Arrhythm 2020; 36:524-527. [PMID: 32528582 PMCID: PMC7279996 DOI: 10.1002/joa3.12336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/08/2020] [Indexed: 11/11/2022] Open
Abstract
Recent studies have shown that cardiac sympathetic denervation (CSD) is effective in the treatment of refractory ventricular tachyarrhythmia in patients with structural heart disease. This case report aimed to highlight the effect of bilateral CSD in suppressing treatment‐resistant ventricular tachycardia in patients with ischemic cardiomyopathy.
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Affiliation(s)
- Yuko Miki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Takehito Sasaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Yoshinori Okazaki
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Mitsuho Inoue
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Katsura Niijima
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Hiroyuki Motoda
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Yutaka Take
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Kentaro Minami
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Nogiku Niwamae
- Department of Cardiovascular Medicine Maebashi Red Cross Hospital Maebashi Gunma Japan
| | | | - Kohki Nakamura
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
| | - Shigeto Naito
- Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Gunma Japan
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17
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Murtaza G, Sharma SP, Akella K, Turagam MK, Rocca DGD, Lakkireddy D, Gopinathannair R. Role of cardiac sympathetic denervation in ventricular tachycardia: A meta‐analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:828-837. [DOI: 10.1111/pace.13968] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Ghulam Murtaza
- Kansas City Heart Rhythm Institute & Research Foundation Overland Park Kansas
| | - Sharan P. Sharma
- Division of Cardiology Garden City Hospital Garden City Michigan
| | - Krishna Akella
- Kansas City Heart Rhythm Institute & Research Foundation Overland Park Kansas
| | - Mohit K. Turagam
- Division of Cardiology Icahn School of Medicine at Mount Sinai New York New York
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18
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La Rovere MT, Porta A, Schwartz PJ. Autonomic Control of the Heart and Its Clinical Impact. A Personal Perspective. Front Physiol 2020; 11:582. [PMID: 32670079 PMCID: PMC7328903 DOI: 10.3389/fphys.2020.00582] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
This essay covers several aspects of the autonomic control of the heart, all relevant to cardiovascular pathophysiology with a direct impact on clinical outcomes. Ischemic heart disease, heart failure, channelopathies, and life-threatening arrhythmias are in the picture. Beginning with an overview on some of the events that marked the oscillations in the medical interest for the autonomic nervous system, our text explores specific areas, including experimental and clinical work focused on understanding the different roles of tonic and reflex sympathetic and vagal activity. The role of the baroreceptors, not just for the direct control of circulation but also because of the clinical value of interpreting alterations (spontaneous or induced) in their function, is discussed. The importance of the autonomic nervous system for gaining insights on risk stratification and for providing specific antiarrhythmic protection is also considered. Examples are the interventions to decrease sympathetic activity and/or to increase vagal activity. The non-invasive analysis of the RR and QT intervals provides additional information. The three of us have collaborated in several studies and each of us contributes with very specific and independent areas of expertise. Here, we have focused on those areas to which we have directly contributed and hence speak with personal experience. This is not an attempt to provide a neutral and general overview on the autonomic nervous system; rather, it represents our effort to share and provide the readers with our own personal views matured after many years of research in this field.
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Affiliation(s)
- Maria Teresa La Rovere
- Department of Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Montescano (Pavia), Italy
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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19
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Verrier RL, Pang TD, Nearing BD, Schachter SC. The Epileptic Heart: Concept and clinical evidence. Epilepsy Behav 2020; 105:106946. [PMID: 32109857 DOI: 10.1016/j.yebeh.2020.106946] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/07/2020] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is generally considered to result from a seizure, typically convulsive and usually but not always occurring during sleep, followed by a sequence of events in the postictal period starting with respiratory distress and progressing to eventual cardiac asystole and death. Yet, recent community-based studies indicate a 3-fold greater incidence of sudden cardiac death in patients with chronic epilepsy than in the general population, and that in 66% of cases, the cardiac arrest occurred during routine daily activity and without a temporal relationship with a typical seizure. To distinguish a primarily cardiac cause of death in patients with epilepsy from the above description of SUDEP, we propose the concept of the "Epileptic Heart" as "a heart and coronary vasculature damaged by chronic epilepsy as a result of repeated surges in catecholamines and hypoxemia leading to electrical and mechanical dysfunction." This review starts with an overview of the pathophysiological and other lines of evidence supporting the biological plausibility of the Epileptic Heart, followed by a description of tools that have been used to generate new electrocardiogram (EKG)-derived data in patients with epilepsy that strongly support the Epileptic Heart concept and its propensity to cause sudden cardiac death in patients with epilepsy independent of an immediately preceding seizure.
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Affiliation(s)
- Richard L Verrier
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America.
| | - Trudy D Pang
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
| | - Bruce D Nearing
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
| | - Steven C Schachter
- Harvard Medical School, Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine and Department of Neurology, Boston, MA United States of America
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20
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Risk factors for primary ventricular fibrillation during a first myocardial infarction: Clinical findings from PREDESTINATION (PRimary vEntricular fibrillation and suDden dEath during firST myocardIal iNfArcTION). Int J Cardiol 2020; 302:164-170. [DOI: 10.1016/j.ijcard.2019.10.060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 11/20/2022]
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21
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Yuan Y, Zhao Y, Wong J, Tsai WC, Jiang Z, Kabir RA, Han S, Shen C, Fishbein MC, Chen LS, Chen Z, Everett TH, Chen PS. Subcutaneous nerve stimulation reduces sympathetic nerve activity in ambulatory dogs with myocardial infarction. Heart Rhythm 2020; 17:1167-1175. [PMID: 32068184 DOI: 10.1016/j.hrthm.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Subcutaneous nerve stimulation (ScNS) remodels the stellate ganglion and reduces stellate ganglion nerve activity (SGNA) in dogs. Acute myocardial infarction (MI) increases SGNA through nerve sprouting. OBJECTIVE The purpose of this study was to test the hypothesis that ScNS remodels the stellate ganglion and reduces SGNA in ambulatory dogs with acute MI. METHODS In the experimental group, a radio transmitter was implanted during the first sterile surgery to record nerve activity and an electrocardiogram, followed by a second sterile surgery to create MI. Dogs then underwent ScNS for 2 months. The average SGNA (aSGNA) was compared with that in a historical control group (n = 9), with acute MI monitored for 2 months without ScNS. RESULTS In the experimental group, the baseline aSGNA and heart rate were 4.08±0.35 μV and 98±12 beats/min, respectively. They increased within 1 week after MI to 6.91±1.91 μV (P=.007) and 107±10 beats/min (P=.028), respectively. ScNS reduced aSGNA to 3.46±0.44 μV (P<.039) and 2.14±0.50 μV (P<.001) at 4 and 8 weeks, respectively, after MI. In comparison, aSGNA at 4 and 8 weeks in dogs with MI but no ScNS was 8.26±6.31 μV (P=.005) and 10.82±7.86 μV (P=0002), respectively. Immunostaining showed confluent areas of remodeling in bilateral stellate ganglia and a high percentage of tyrosine hydroxylase-negative ganglion cells. Terminal deoxynucleotidyl transferase dUTP nick end labeling was positive in 26.61%±11.54% of ganglion cells in the left stellate ganglion and 15.94%±3.62% of ganglion cells in the right stellate ganglion. CONCLUSION ScNS remodels the stellate ganglion, reduces SGNA, and suppresses cardiac nerve sprouting after acute MI.
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Affiliation(s)
- Yuan Yuan
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Zhao
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiac Surgery, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Johnson Wong
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wei-Chung Tsai
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zhaolei Jiang
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ryan A Kabir
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Seongwook Han
- Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
| | - Changyu Shen
- Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael C Fishbein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Lan S Chen
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Zhenhui Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Thomas H Everett
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Peng-Sheng Chen
- The Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
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22
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Safi S, Sethi NJ, Nielsen EE, Feinberg J, Gluud C, Jakobsen JC. Beta-blockers for suspected or diagnosed acute myocardial infarction. Cochrane Database Syst Rev 2019; 12:CD012484. [PMID: 31845756 PMCID: PMC6915833 DOI: 10.1002/14651858.cd012484.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiovascular disease is the number one cause of death globally. According to the World Health Organization, 7.4 million people died from ischaemic heart diseases in 2012, constituting 15% of all deaths. Acute myocardial infarction is caused by blockage of the blood supplied to the heart muscle. Beta-blockers are often used in patients with acute myocardial infarction. Previous meta-analyses on the topic have shown conflicting results ranging from harms, neutral effects, to benefits. No previous systematic review using Cochrane methodology has assessed the effects of beta-blockers for acute myocardial infarction. OBJECTIVES To assess the benefits and harms of beta-blockers compared with placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, LILACS, Science Citation Index Expanded and BIOSIS Citation Index in June 2019. We also searched the WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Turning Research into Practice, Google Scholar, SciSearch, and the reference lists of included trials and previous reviews in August 2019. SELECTION CRITERIA We included all randomised clinical trials assessing the effects of beta-blockers versus placebo or no intervention in people with suspected or diagnosed acute myocardial infarction. Trials were included irrespective of trial design, setting, blinding, publication status, publication year, language, and reporting of our outcomes. DATA COLLECTION AND ANALYSIS We followed the Cochrane methodological recommendations. Four review authors independently extracted data. Our primary outcomes were all-cause mortality, serious adverse events according to the International Conference on Harmonization - Good Clinical Practice (ICH-GCP), and major adverse cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial infarction during follow-up). Our secondary outcomes were quality of life, angina, cardiovascular mortality, and myocardial infarction during follow-up. Our primary time point of interest was less than three months after randomisation. We also assessed the outcomes at maximum follow-up beyond three months. Due to risk of multiplicity, we calculated a 97.5% confidence interval (CI) for the primary outcomes and a 98% CI for the secondary outcomes. We assessed the risks of systematic errors through seven bias domains in accordance to the instructions given in the Cochrane Handbook. The quality of the body of evidence was assessed by GRADE. MAIN RESULTS We included 63 trials randomising a total of 85,550 participants (mean age 57.4 years). Only one trial was at low risk of bias. The remaining trials were at high risk of bias. The quality of the evidence according to GRADE ranged from very low to high. Fifty-six trials commenced beta-blockers during the acute phase of acute myocardial infarction and seven trials during the subacute phase. At our primary time point 'less than three months follow-up', meta-analysis showed that beta-blockers versus placebo or no intervention probably reduce the risk of a reinfarction during follow-up (risk ratio (RR) 0.82, 98% confidence interval (CI) 0.73 to 0.91; 67,562 participants; 18 trials; moderate-quality evidence) with an absolute risk reduction of 0.5% and a number needed to treat for an additional beneficial outcome (NNTB) of 196 participants. However, we found little or no effect of beta-blockers when assessing all-cause mortality (RR 0.94, 97.5% CI 0.90 to 1.00; 80,452 participants; 46 trials/47 comparisons; high-quality evidence) with an absolute risk reduction of 0.4% and cardiovascular mortality (RR 0.99, 95% CI 0.91 to 1.08; 45,852 participants; 1 trial; moderate-quality evidence) with an absolute risk reduction of 0.4%. Regarding angina, it is uncertain whether beta-blockers have a beneficial or harmful effect (RR 0.70, 98% CI 0.25 to 1.84; 98 participants; 3 trials; very low-quality evidence) with an absolute risk reduction of 7.1%. None of the trials specifically assessed nor reported serious adverse events according to ICH-GCP. Only two trials specifically assessed major adverse cardiovascular events, however, no major adverse cardiovascular events occurred in either trial. At maximum follow-up beyond three months, meta-analyses showed that beta-blockers versus placebo or no intervention probably reduce the risk of all-cause mortality (RR 0.93, 97.5% CI 0.86 to 0.99; 25,210 participants; 21 trials/22 comparisons; moderate-quality evidence) with an absolute risk reduction of 1.1% and a NNTB of 91 participants, and cardiovascular mortality (RR 0.90, 98% CI 0.83 to 0.98; 22,457 participants; 14 trials/15 comparisons; moderate-quality evidence) with an absolute risk reduction of 1.2% and a NNTB of 83 participants. However, it is uncertain whether beta-blockers have a beneficial or harmful effect when assessing major adverse cardiovascular events (RR 0.81, 97.5% CI 0.40 to 1.66; 475 participants; 4 trials; very low-quality evidence) with an absolute risk reduction of 1.7%; reinfarction (RR 0.89, 98% CI 0.75 to 1.08; 6825 participants; 14 trials; low-quality evidence) with an absolute risk reduction of 0.9%; and angina (RR 0.64, 98% CI 0.18 to 2.0; 844 participants; 2 trials; very low-quality evidence). None of the trials specifically assessed nor reported serious adverse events according to ICH-GCP. None of the trials assessed quality of life. We identified two ongoing randomised clinical trials investigating the effect of early administration of beta-blockers after percutaneous coronary intervention or thrombolysis to patients with an acute myocardial infarction and one ongoing trial investigating the effect of long-term beta-blocker therapy. AUTHORS' CONCLUSIONS Our present review indicates that beta-blockers for suspected or diagnosed acute myocardial infarction probably reduce the short-term risk of a reinfarction and the long-term risk of all-cause mortality and cardiovascular mortality. Nevertheless, it is most likely that beta-blockers have little or no effect on the short-term risk of all-cause mortality and cardiovascular mortality. Regarding all remaining outcomes (serious adverse events according to ICH-GCP, major adverse cardiovascular events (composite of cardiovascular mortality and non-fatal myocardial infarction during follow-up), the long-term risk of a reinfarction during follow-up, quality of life, and angina), further information is needed to confirm or reject the clinical effects of beta-blockers on these outcomes for people with or suspected of acute myocardial infarction.
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Affiliation(s)
- Sanam Safi
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Naqash J Sethi
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
- Cardiology SectionDepartment of Internal MedicineSmedelundsgade 60HolbækDanmarkDenmark4300
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Christian Gluud
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
- University of Southern DenmarkDepartment of Regional Health Research, the Faculty of Health SciencesHolbaekDenmark
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Miraglia D, Miguel LA, Alonso W. The evolving role of novel treatment techniques in the management of patients with refractory VF/pVT out-of-hospital cardiac arrest. Am J Emerg Med 2019; 38:648-654. [PMID: 31836341 DOI: 10.1016/j.ajem.2019.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES The purpose of this review is to provide a brief overview of new life-saving interventions and novel techniques that have been proposed as viable treatment options for patients presenting with refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) out-of-hospital cardiac arrest (OHCA). METHODS We conducted a comprehensive literature search of PubMed recent, Medline and Embase databases via the Ovid interface and Google Scholar from inception to July 2019. Eligible studies were observational in nature reporting outcomes of extracorporeal membrane oxygenation (ECMO), esmolol, double sequential defibrillation (DSD), and stellate ganglion block (SGB). Two investigators conducted the literature search, study selection, and data extraction. Any disagreements were resolved by consensus. RESULTS Our database search identified 5331 records. We included in our review 23 articles that met our inclusion criteria. The selected studies included 16 observational studies on ECMO, 2 observational studies on esmolol, and 5 observational studies on DSD. CONCLUSION We would like to suggest that there is not enough evidence in the existing literature to support at large-scale the effects of these techniques in the treatment of refractory VF/pVT OHCA. Randomized studies are warranted to evaluate the significant effects of these approaches against the best current standard of care.
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Affiliation(s)
- Dennis Miraglia
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United States.
| | - Lourdes A Miguel
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United States
| | - Wilfredo Alonso
- Department of Internal Medicine, Good Samaritan Hospital, Aguadilla, PR, United States
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24
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Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with structural heart disease: A systematic review. Heart Rhythm 2019; 16:1499-1505. [DOI: 10.1016/j.hrthm.2019.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 01/04/2023]
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25
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Waldron NH, Fudim M, Mathew JP, Piccini JP. Neuromodulation for the Treatment of Heart Rhythm Disorders. JACC Basic Transl Sci 2019; 4:546-562. [PMID: 31468010 PMCID: PMC6712352 DOI: 10.1016/j.jacbts.2019.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 12/13/2022]
Abstract
Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis. Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias. Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
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Key Words
- AERP, atrial effective refractory period
- AF, atrial fibrillation
- AGP, autonomic ganglionic plexus
- ANS, autonomic nervous system
- CABG, coronary artery bypass grafting
- HRV, heart rate variability
- ICD, implantable cardioverter-defibrillator
- LLVNS, low-level vagal nerve stimulation
- OSA, obstructive sleep apnea
- POAF, post-operative atrial fibrillation
- PVI, pulmonary vein isolation
- RDN, renal denervation
- SCS, spinal cord stimulation
- SGB, stellate ganglion blockade
- SNS, sympathetic nervous system
- VF, ventricular fibrillation
- VNS, vagal nerve stimulation
- VT, ventricular tachycardia
- arrhythmia
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- neuromodulation
- ventricular arrhythmias
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Affiliation(s)
- Nathan H Waldron
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
| | - Joseph P Mathew
- Department of Anesthesia, Duke University Medical Center, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Durham, North Carolina.,Electrophysiology Section, Duke University Medical Center, Durham, North Carolina
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26
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Cai C, Dai MY, Tian Y, Zhang P, Wittwer ED, Rho RH, Kapa S, McLeod CJ, Mulpuru SK, Lee HC, Ackerman MJ, Asirvatham SJ, Munger TM, Chen ML, Friedman PA, Cha YM. Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease. J Cardiovasc Electrophysiol 2019; 30:1499-1507. [PMID: 31199536 DOI: 10.1111/jce.14030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Autonomic modulation has been used as a therapy to control recurrent ventricular arrhythmia (VA). This study was to explore stellate ganglion block (SGB) effect on cardiac electrophysiologic properties and evaluate the long-term outcome of cardiac sympathetic denervation (CSD) for patients with recurrent VA and structural heart disease (SHD). MATERIALS AND METHODS Patients who had recurrent VA due to SHD were enrolled prospectively. Electrophysiologic study and ventricular tachycardia (VT) induction were performed before and after left and right SGB. VA burden and long-term outcomes were assessed for a separate patient group who underwent left or bilateral CSD for drug-refractory VA due to SHD. RESULTS Electrophysiologic study of nine patients showed that baseline mean (SD) corrected sinus node recovery time (cSNRT) increased from 320.4 (73.3) ms to 402.9 (114.2) ms after left and 482.4 (95.7) ms after bilateral SGB (P = .03). SGB did not significantly change P-R, QRS, and Q-T intervals and ventricular effective refractory period, nor did the inducibility of VA. Nineteen patients underwent left (n = 14) or bilateral (n = 5) CSD. CSD reduced VA burden and appropriate ICD therapies from a median (interquartile range) of 2.5 (0.4-11.6) episodes weekly to 0.1 (0.0-2.4) episodes weekly at 6-month follow-up (P = .002). Three-year freedom from orthotopic heart transplant (OHT) and death was 52.6%. New York Heart Association functional class III/IV and VT rate less than 160 beats per minute were predictors of recurrent VA, OHT, and death. CONCLUSION SGB increased cSNRT without changing heart rate. CSD was more beneficial for patients with mild-to-moderate heart failure and faster VA.
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Affiliation(s)
- Cheng Cai
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ming-Yan Dai
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Hubei Key Laboratory of Cardiology, Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Wuhan, China
| | - Ying Tian
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Cardiovascular Diseases, Beijing Chaoyang Hospital, Beijing, China
| | - Pei Zhang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Erica D Wittwer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Richard H Rho
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Siva K Mulpuru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hon-Chi Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Thomas M Munger
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ming-Long Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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27
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Assis FR, Krishnan A, Zhou X, James CA, Murray B, Tichnell C, Berger R, Calkins H, Tandri H, Mandal K. Cardiac sympathectomy for refractory ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2019; 16:1003-1010. [DOI: 10.1016/j.hrthm.2019.01.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Indexed: 11/28/2022]
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28
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Cronin EM, Bogun FM, Maury P, Peichl P, Chen M, Namboodiri N, Aguinaga L, Leite LR, Al-Khatib SM, Anter E, Berruezo A, Callans DJ, Chung MK, Cuculich P, d'Avila A, Deal BJ, Della Bella P, Deneke T, Dickfeld TM, Hadid C, Haqqani HM, Kay GN, Latchamsetty R, Marchlinski F, Miller JM, Nogami A, Patel AR, Pathak RK, Saenz Morales LC, Santangeli P, Sapp JL, Sarkozy A, Soejima K, Stevenson WG, Tedrow UB, Tzou WS, Varma N, Zeppenfeld K. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias. Heart Rhythm 2019; 17:e2-e154. [PMID: 31085023 PMCID: PMC8453449 DOI: 10.1016/j.hrthm.2019.03.002] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 01/10/2023]
Abstract
Ventricular arrhythmias are an important cause of morbidity and mortality and come in a variety of forms, from single premature ventricular complexes to sustained ventricular tachycardia and fibrillation. Rapid developments have taken place over the past decade in our understanding of these arrhythmias and in our ability to diagnose and treat them. The field of catheter ablation has progressed with the development of new methods and tools, and with the publication of large clinical trials. Therefore, global cardiac electrophysiology professional societies undertook to outline recommendations and best practices for these procedures in a document that will update and replace the 2009 EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias. An expert writing group, after reviewing and discussing the literature, including a systematic review and meta-analysis published in conjunction with this document, and drawing on their own experience, drafted and voted on recommendations and summarized current knowledge and practice in the field. Each recommendation is presented in knowledge byte format and is accompanied by supportive text and references. Further sections provide a practical synopsis of the various techniques and of the specific ventricular arrhythmia sites and substrates encountered in the electrophysiology lab. The purpose of this document is to help electrophysiologists around the world to appropriately select patients for catheter ablation, to perform procedures in a safe and efficacious manner, and to provide follow-up and adjunctive care in order to obtain the best possible outcomes for patients with ventricular arrhythmias.
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Affiliation(s)
| | | | | | - Petr Peichl
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Minglong Chen
- Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Elad Anter
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Andre d'Avila
- Hospital Cardiologico SOS Cardio, Florianopolis, Brazil
| | - Barbara J Deal
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Claudio Hadid
- Hospital General de Agudos Cosme Argerich, Buenos Aires, Argentina
| | - Haris M Haqqani
- University of Queensland, The Prince Charles Hospital, Chermside, Australia
| | - G Neal Kay
- University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | - John M Miller
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana
| | | | - Akash R Patel
- University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | | | | | | | - John L Sapp
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada
| | - Andrea Sarkozy
- University Hospital Antwerp, University of Antwerp, Antwerp, Belgium
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29
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Lai Y, Yu L, Jiang H. Autonomic Neuromodulation for Preventing and Treating Ventricular Arrhythmias. Front Physiol 2019; 10:200. [PMID: 30914967 PMCID: PMC6421499 DOI: 10.3389/fphys.2019.00200] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/15/2019] [Indexed: 12/18/2022] Open
Abstract
The cardiac autonomic nervous system (CANS) is associated with modulation of cardiac electrophysiology and arrhythmogenesis. In this mini review, we will briefly introduce cardiac autonomic anatomy and autonomic activity in ventricular arrhythmias (VAs) and discuss novel approaches of CANS modulation for treating VAs. Studies over the decades have provided a better understanding of cardiac autonomic innervation and revealed overwhelming evidence of the relationship between autonomic tone and VAs. A high sympathetic tone and low parasympathetic (vagal) tone are considered as the major triggers of VAs in patients with myocardial ischemia, which can cause sudden cardiac death. In recent years, novel methods of autonomic neuromodulation have been investigated to prevent VAs, and they have been verified as being beneficial for malignant VAs in animal models and humans. The clinical outcome of autonomic neuromodulation depends on the level of cardiac neuraxis, stimulation parameters, and patient's pathological status. Since autonomic modulation for VA treatment is still in the early stage of clinical application, more basic and clinical studies should be performed to clarify these mechanisms and optimize autonomic neuromodulation therapies for patients with VAs in the future.
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Affiliation(s)
- Yanqiu Lai
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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30
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Carnagarin R, Kiuchi MG, Ho JK, Matthews VB, Schlaich MP. Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation. Front Neurosci 2019; 12:1058. [PMID: 30728760 PMCID: PMC6351490 DOI: 10.3389/fnins.2018.01058] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022] Open
Abstract
The autonomic nervous system (ANS) has a significant influence on the structural integrity and electrical conductivity of the atria. Aberrant activation of the sympathetic nervous system can induce heterogeneous changes with arrhythmogenic potential which can result in atrial tachycardia, atrial tachyarrhythmias and atrial fibrillation (AF). Methods to modulate autonomic activity primarily through reduction of sympathetic outflow reduce the incidence of spontaneous or induced atrial arrhythmias in animal models and humans, suggestive of the potential application of such strategies in the management of AF. In this review we focus on the relationship between the ANS, sympathetic overdrive and the pathophysiology of AF, and the potential of sympathetic neuromodulation in the management of AF. We conclude that sympathetic activity plays an important role in the initiation and maintenance of AF, and modulating ANS function is an important therapeutic approach to improve the management of AF in selected categories of patients. Potential therapeutic applications include pharmacological inhibition with central and peripheral sympatholytic agents and various device based approaches. While the role of the sympathetic nervous system has long been recognized, new developments in science and technology in this field promise exciting prospects for the future.
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Affiliation(s)
- Revathy Carnagarin
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Marcio G Kiuchi
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Jan K Ho
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Vance B Matthews
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
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31
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Schwartz PJ, Pugliese L. Cardiac sympathetic denervation via a transtracheal approach: It’s a long way to Tipperary. Heart Rhythm 2019; 16:125-127. [DOI: 10.1016/j.hrthm.2018.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 12/20/2022]
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32
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Saddic LA, Howard-Quijano K, Kipke J, Kubo Y, Dale EA, Hoover D, Shivkumar K, Eghbali M, Mahajan A. Progression of myocardial ischemia leads to unique changes in immediate-early gene expression in the spinal cord dorsal horn. Am J Physiol Heart Circ Physiol 2018; 315:H1592-H1601. [PMID: 30216122 PMCID: PMC6336975 DOI: 10.1152/ajpheart.00337.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/07/2018] [Accepted: 09/07/2018] [Indexed: 11/22/2022]
Abstract
The pathological consequences of ischemic heart disease involve signaling through the autonomic nervous system. Although early activation may serve to maintain hemodynamic stability, persistent aberrant sympathoexcitation contributes to the development of lethal arrhythmias and heart failure. We hypothesized that as the myocardium reacts and remodels to ischemic injury over time, there is an analogous sequence of gene expression changes in the thoracic spinal cord dorsal horn, the processing center for incoming afferent fibers from the heart to the central nervous system. Acute and chronic myocardial ischemia (MI) was induced in a large animal model of Yorkshire pigs, and the thoracic dorsal horn of treated pigs, along with control nonischemic pigs, was harvested for transcriptome analysis. We identified 32 differentially expressed genes between healthy and acute ischemia cohorts and 46 differentially expressed genes between healthy and chronic ischemia cohorts. The canonical immediate-early gene c-fos was upregulated after acute MI, along with fosB, dual specificity phosphatase 1 and 2 ( dusp1 and dusp2), and early growth response 2 (egr2). After chronic MI, there was a persistent yet unique activation of immediate-early genes, including fosB, nuclear receptor subfamily 4 group A members 1-3 ( nr4a1, nr4a2, and nr4a3), egr3, and TNF-α-induced protein 3 ( tnfaip3). In addition, differentially expressed genes from the chronic MI signature were enriched in pathways linked to apoptosis, immune regulation, and the stress response. These findings support a dynamic progression of gene expression changes in the dorsal horn with maturation of myocardial injury, and they may explain how early adaptive autonomic nervous system responses can maintain hemodynamic stability, whereas prolonged maladaptive signals can predispose patients to arrhythmias and heart failure. NEW & NOTEWORTHY Activation of the autonomic nervous system after myocardial injury can provide early cardiovascular support or prolonged aberrant sympathoexcitation. The later response can lead to lethal arrhythmias and heart failure. This study provides evidence of ongoing changes in the gene expression signature of the spinal cord dorsal horn as myocardial injury progresses over time. These changes could help explain how an adaptive nervous system response can become maladaptive over time.
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Affiliation(s)
- Louis A Saddic
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Jasmine Kipke
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Yukiko Kubo
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Erica A Dale
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Donald Hoover
- Quillen College of Medicine, Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Mansoureh Eghbali
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California , Los Angeles, California
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33
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2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm 2018; 15:e73-e189. [DOI: 10.1016/j.hrthm.2017.10.036] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 02/07/2023]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e210-e271. [PMID: 29084733 DOI: 10.1161/cir.0000000000000548] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. Section numbers pertain to those in the full-text guideline. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2018; 138:e272-e391. [PMID: 29084731 DOI: 10.1161/cir.0000000000000549] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - William G Stevenson
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael J Ackerman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - William J Bryant
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - David J Callans
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne B Curtis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Barbara J Deal
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Timm Dickfeld
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Michael E Field
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Gregg C Fonarow
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Anne M Gillis
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Christopher B Granger
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Stephen C Hammill
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Mark A Hlatky
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - José A Joglar
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - G Neal Kay
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Daniel D Matlock
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Robert J Myerburg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | - Richard L Page
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. †ACC/AHA Representative. ‡HRS Representative. §ACC/AHA Task Force on Performance Measures Liaison/HFSA Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2018; 72:e91-e220. [PMID: 29097296 DOI: 10.1016/j.jacc.2017.10.054] [Citation(s) in RCA: 717] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Liu S, Yu X, Luo D, Qin Z, Wang X, He W, Ma R, Hu H, Xie J, He B, Lu Z, Jiang H. Ablation of the Ligament of Marshall and Left Stellate Ganglion Similarly Reduces Ventricular Arrhythmias During Acute Myocardial Infarction. Circ Arrhythm Electrophysiol 2018; 11:e005945. [PMID: 29700056 DOI: 10.1161/circep.117.005945] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/12/2018] [Indexed: 01/09/2023]
Abstract
Background:
Sympathetic denervation exerts protective effects against ventricular arrhythmias (VAs) induced by acute myocardial infarction. The results of a previous study indicated that the distal part of the ligament of Marshall (LOM
LSPV
) might be a sympathetic conduit between the left stellate ganglion (LSG) and the ventricles. The present study was designed to compare the effects between LSG and LOM
LSPV
ablation on ischemia-induced VAs.
Methods:
Twenty-nine dogs were randomly divided into sham ablation group (group 1, n=9), LOM
LSPV
ablation group (group 2, n=10), and LSG ablation group (group 3, n=10). Ablation was performed before occlusion of the left anterior coronary artery. Changes in the heart rate variability, serum norepinephrine, ventricular effective refractory period, and blood pressure induced by LSG stimulation were observed, and the occurrence of VAs was recorded. Immunostaining examinations of LOM
LSPV
were performed in dogs without ablation.
RESULTS:
In group 2, LOM
LSPV
ablation evidently attenuated blood pressure elevation induced by LSG stimulation. Both LOM
LSPV
ablation and LSG ablation similarly prolonged ventricular effective refractory period and reduced the concentration of serum norepinephrine, the sympathetic index of heart rate variability, and the incidence of VAs compared with sham ablation. Abundant sympathetic nerve fibers were observed in LOM
LSPV
.
Conclusions:
LOM
LSPV
ablation prevented acute myocardial infarction–induced VAs with the same efficiency as LSG ablation, potentially by blocking the sympathetic pathway from the LSG to the heart.
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Affiliation(s)
- Shan Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Xiaomei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Da Luo
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Zhiliang Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Xiaoying Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Wenbo He
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Ruisong Ma
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Huihui Hu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Jing Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Bo He
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
| | - Zhibing Lu
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Department of Cardiology, Huangshi Central Hospital, Hubei Polytechnic University, China (Z.L.)
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Cardiovascular Research Institute, Wuhan University, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
- Hubei Key Laboratory of Cardiology, Wuhan, China (S.L., X.Y., D.L., Z.Q., X.W., W.H., R.M., H.H., J.X., B.H., Z.L., H.J.)
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Wang L, Sun L, Wang K, Jin Y, Liu Q, Xia Z, Liu X, Zhang J, Li J. Stimulation of Epicardial Sympathetic Nerves at Different Sites Induces Cardiac Electrical Instability to Various Degrees. Sci Rep 2018; 8:994. [PMID: 29343857 PMCID: PMC5772557 DOI: 10.1038/s41598-018-19304-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 12/29/2017] [Indexed: 01/01/2023] Open
Abstract
The cardiac sympathetic nerves distribute across cardiac tissues with uneven density. Yet, to what extent this anatomical heterogeneity affects electrical activity of the left ventricle is largely unknown. Dogs were randomized into non-stimulation control (NC), posterior basal-stimulation (PB), anterior superior-stimulation (AS), apical part-stimulation (AP) group. The epicardial sympathetic nerves at different sites along their distribution were with electrical stimulation (ES) for 4 hours except in the NC group. The myocardial effective refractory period (ERP), ventricular fibrillation threshold (VFT) and density of sympathetic nerves were recorded. Compared with ES at other places, the stimulation at PB site significantly shortened ERP (left ventricular anterior and posterior walls; PB group, 118 ± 4 ms, 106 ± 2 ms; Versus NC group, 155 ± 3.5 ms, 160 ± 3 ms; p < 0.01) and VFT (PB group, 11.5 ± 1.5 V; Versus NC group, 20.5 ± 0.9 V; p < 0.01), and induced remarkable regeneration of the cardiac sympathetic nerves, hence influencing electrical activity of the left ventricle to the most extent. Our study demonstrates that the degree of induced ventricular electrical instability is correlated tightly with the density of sympathetic nerves around ES site, and PB site is a potential target for modulating ventricular electrical activity to the maximal extent.
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Affiliation(s)
- Liang Wang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lin Sun
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kun Wang
- Henan Provincial Chest Hospital, Henan, China
| | - Yingying Jin
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhongnan Xia
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xudong Liu
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiakun Zhang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingjie Li
- The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Wang M, Li S, Zhou X, Huang B, Zhou L, Li X, Meng G, Yuan S, Wang Y, Wang Z, Wang S, Yu L, Jiang H. Increased inflammation promotes ventricular arrhythmia through aggravating left stellate ganglion remodeling in a canine ischemia model. Int J Cardiol 2017; 248:286-293. [DOI: 10.1016/j.ijcard.2017.08.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/29/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022]
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 72:1677-1749. [PMID: 29097294 DOI: 10.1016/j.jacc.2017.10.053] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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41
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Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Granger CB, Hammill SC, Hlatky MA, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm 2017; 15:e190-e252. [PMID: 29097320 DOI: 10.1016/j.hrthm.2017.10.035] [Citation(s) in RCA: 392] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Indexed: 12/23/2022]
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van Bilsen M, Patel HC, Bauersachs J, Böhm M, Borggrefe M, Brutsaert D, Coats AJS, de Boer RA, de Keulenaer GW, Filippatos GS, Floras J, Grassi G, Jankowska EA, Kornet L, Lunde IG, Maack C, Mahfoud F, Pollesello P, Ponikowski P, Ruschitzka F, Sabbah HN, Schultz HD, Seferovic P, Slart RHJA, Taggart P, Tocchetti CG, Van Laake LW, Zannad F, Heymans S, Lyon AR. The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 19:1361-1378. [PMID: 28949064 DOI: 10.1002/ejhf.921] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/23/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022] Open
Abstract
Despite improvements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future?
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Affiliation(s)
- Marc van Bilsen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Hitesh C Patel
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Michael Böhm
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Martin Borggrefe
- First Department of Medicine, Cardiology Division, University Medical Centre Mannheim, Mannheim, Germany.,German Centre for Cardiovascular Research, Mannheim, Germany
| | - Dirk Brutsaert
- Department of Cardiology, Antwerp University, Antwerp, Belgium
| | - Andrew J S Coats
- Department of Medicine, Monash University, Melbourne, Vic, Australia.,Department of Medicine, University of Warwick, Coventry, UK
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Gerasimos S Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - John Floras
- University Health Network and Sinai Health System Division of Cardiology, Peter Munk Cardiac Centre, Toronto General and Lunenfeld-Tanenbaum Research Institutes, University of Toronto, Toronto, ON, Canada
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Milan, Italy
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Lilian Kornet
- Medtronic, Inc., Bakken Research Centre, Maastricht, the Netherlands
| | - Ida G Lunde
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Christoph Maack
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Felix Mahfoud
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Harold D Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Petar Seferovic
- Department of Cardiology, Belgrade University Medical Centre, Belgrade, Serbia
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Peter Taggart
- Department of Cardiovascular Science, University College London, Barts Heart Centre, London, UK
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Linda W Van Laake
- Department of Cardiology, Heart and Lungs Division, and Regenerative Medicine Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Faiez Zannad
- INSERM, Centre for Clinical Investigation 9501, Unit 961, University Hospital Centre, Nancy, France.,Department of Cardiology, Nancy University, University of the Lorraine, Nancy, France
| | - Stephane Heymans
- Netherlands Heart Institute, Utrecht, the Netherlands.,Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium
| | - Alexander R Lyon
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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Abstract
PURPOSE OF REVIEW Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality. In addition, shocks may have deleterious mechanical and psychological effects. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. RECENT FINDINGS There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease; there are no randomized studies for non-ischemic ventricular substrates. The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy. Early catheter ablation may be appropriate in some clinical situations such as patients presenting with relatively slow VT below ICD detection, electrical storms, hemodynamically stable VT, or in very selected patients with left ventricular assist devices. The optimal first-line suppressive therapy for VT, after ICD implantation and appropriate programming, remains to be determined. Thus far, there has not been a randomized controlled trial to compare catheter ablation to antiarrhythmic drug therapy as a first-line treatment; the VANISH-2 study has been initiated as a pilot to examine this question.
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Affiliation(s)
- Amir AbdelWahab
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada
| | - John Sapp
- QEII Health Sciences Centre, Room 2501 B/F Halifax Infirmary 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
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Fudim M, Boortz-Marx R, Ganesh A, Waldron NH, Qadri YJ, Patel CB, Milano CA, Sun AY, Mathew JP, Piccini JP. Stellate ganglion blockade for the treatment of refractory ventricular arrhythmias: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2017; 28:1460-1467. [PMID: 28833780 DOI: 10.1111/jce.13324] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Treatment refractory ventricular arrhythmias (VAs) are often driven and exacerbated by heightened sympathetic tone. We aim to conduct a systematic review and meta-analysis of published studies of a temporary percutaneous stellate ganglion block (SGB) on VA burden and defibrillation episodes in patients with treatment refractory VAs. METHODS Relevant studies from January 1960 through May 2017 were identified in PubMed and Google Scholar. We performed a patient-level analysis using Student's t-test to compare outcomes before and after SGB. RESULTS We identified 22 unique case series with a total of 35 patients. Patients were 57 ± 17 years old and 69% were males with a high burden of VA. A unilateral (left)-sided SGB was used in 85.7% (30 of 35) of cases and the remaining were bilateral SGB. The use of a unilateral or bilateral SGB resulted in a significant reduction of VA episodes (24-hours pre: mean 16.5 [CI 9.7-23.1] events vs. post: mean 1.4 [CI 0.85-2.01] events; P = 0.0002) and need for defibrillation (24-hours pre: mean 14.2 [CI 6.8-21.6] vs. post: mean 0.6 [CI 0.3-0.9]; P = 0.0026). Furthermore, SGB was significantly associated with a reduction of VA burden regardless of etiology of cardiomyopathy, type of ventricular rhythm, and degree of contractile dysfunction. SGB was followed by surgical sympathectomy in 21% of cases. CONCLUSIONS Early experience suggests that SGB is associated with an acute reduction in the VA burden and offers potential promise for a broader use in high-risk populations. Randomized controlled studies are needed to confirm the safety and efficacy of this therapy.
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Affiliation(s)
- Marat Fudim
- Duke Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Richard Boortz-Marx
- Duke Anesthesiology - Division of Pain Medicine, Duke University, Durham, NC, USA
| | - Arun Ganesh
- Duke Anesthesiology - Division of Pain Medicine, Duke University, Durham, NC, USA
| | | | - Yawar J Qadri
- Duke Anesthesiology - Division of Pain Medicine, Duke University, Durham, NC, USA
| | - Chetan B Patel
- Duke Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Carmelo A Milano
- Cardiothoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Albert Y Sun
- Duke Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Jonathan P Piccini
- Duke Cardiology, Duke University Medical Center, Durham, NC, USA.,Duke Center for Atrial Fibrillation, Duke University Medical Center, Duke University, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
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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. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. J Am Coll Cardiol 2017. [PMID: 28641796 DOI: 10.1016/j.jacc.2017.04.035] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT). OBJECTIVES This study assessed the value of CSD and the characteristics associated with outcomes in this population. METHODS Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD. RESULTS Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before 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 functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional 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 taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up. CONCLUSIONS 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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Affiliation(s)
- Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California; Neurocardiology Research Center of Excellence at UCLA, Los Angeles, California.
| | - Parag Barwad
- Holy Family Heart Institute, Holy Family Hospital, Mumbai, India
| | | | - Harikrishna Tandri
- Johns Hopkins Heart and Vascular Institute, Johns Hopkins University, Baltimore, Maryland
| | - Nilesh Mathuria
- Baylor St. Luke's Medical Center/Texas Heart Institute, Baylor College of Medicine, Houston, Texas
| | - Rushil Shah
- Holy Family Heart Institute, Holy Family Hospital, Mumbai, India
| | - Julie M Sorg
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Jean Gima
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Kaushik Mandal
- Johns Hopkins Heart and Vascular Institute, Johns Hopkins University, Baltimore, Maryland
| | - Luis C Sàenz Morales
- Centro Internacional de Arritmias, Fundacion Cardio Infantil-Instituto de Cardiologia, Bogota, Colombia
| | - Yash Lokhandwala
- Holy Family Heart Institute, Holy Family Hospital, Mumbai, India
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, University of California, Los Angeles, California; Neurocardiology Research Center of Excellence at UCLA, Los Angeles, California
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46
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Chin A, Ntsekhe M, Viljoen C, Rossouw J, Pennel T, Schwartz PJ. Rationale and design of a prospective study to assess the effect of left cardiac sympathetic denervation in chronic heart failure. Int J Cardiol 2017; 248:227-231. [PMID: 28864134 DOI: 10.1016/j.ijcard.2017.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The main causes of mortality in patients with chronic heart failure include sudden cardiac death (SCD) and progressive heart failure. Autonomic dysfunction plays a detrimental role in the progression of chronic heart failure. Left cardiac sympathetic denervation (LCSD) is an inexpensive and safe procedure which modifies autonomic innervation of the heart and is associated with a significant antifibrillatory effect. Whether LCSD reduces the risk of SCD, delays progression of heart failure and improves quality of life in patients with heart failure with reduced ejection fraction (HFrEF) is not known. METHODS AND DESIGN This is a 2-phased prospective, randomized trial to test the efficacy and safety of LCSD as an adjunct to guideline recommended medical therapy for patients with HFrEF. Once the safety and feasibility of conducting a large LCSD study have been demonstrated in the pilot phase, a phase III efficacy trial to assess the impact on ventricular arrhythmias, heart failure outcomes, and mortality will be completed. Outcome data from the pilot study will remain blinded and added to the results of phase III study for analysis. RESULTS To date the study has received approval from local and national ethics and regulatory bodies and recruitment has commenced, and 4 patients have been randomized so far. CONCLUSION If LCSD is proven to be safe, feasible and effective in this first ever study using this novel approach in patients with HFrEF it may be a cost-effective alternative to the implantable cardioverter defibrillator therapy especially in regions where ICDs and cardiac transplantation are unavailable.
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Affiliation(s)
- Ashley Chin
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Charle Viljoen
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Johan Rossouw
- Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
| | - Tim Pennel
- Christiaan Barnard Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of Cape Town, 7925, Observatory, Cape Town, South Africa
| | - Peter J Schwartz
- Division of Cardiology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa; IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy.
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Gao C, Howard-Quijano K, Rau C, Takamiya T, Song Y, Shivkumar K, Wang Y, Mahajan A. Inflammatory and apoptotic remodeling in autonomic nervous system following myocardial infarction. PLoS One 2017; 12:e0177750. [PMID: 28542617 PMCID: PMC5436752 DOI: 10.1371/journal.pone.0177750] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/02/2017] [Indexed: 01/09/2023] Open
Abstract
Background Chronic myocardial infarction (MI) triggers pathological remodeling in the heart and cardiac nervous system. Abnormal function of the autonomic nervous system (ANS), including stellate ganglia (SG) and dorsal root ganglia (DRG) contribute to increased sympathoexcitation, cardiac dysfunction and arrythmogenesis. ANS modulation is a therapeutic target for arrhythmia associated with cardiac injury. However, the molecular mechanism involved in the pathological remodeling in ANS following cardiac injury remains to be established. Methods and results In this study, we performed transcriptome analysis by RNA-sequencing in thoracic SG and (T1-T4) DRG obtained from Yorkshire pigs following either acute (3 to 5 hours) or chronic (8 weeks) myocardial infarction. By differential expression and weighted gene co-expression network analysis (WGCNA), we identified significant transcriptome changes and specific gene modules in the ANS tissues in response to myocardial infarction at either acute or chronic phases. Both differential expressed genes and the member genes of the WGCNA gene module associated with post-infarct condition were significantly enriched for inflammatory signaling and apoptotic cell death. Targeted validation analysis supported a significant induction of inflammatory and apoptotic signal in both SG and DRG following myocardial infarction, along with cellular evidence of apoptosis induction based on TUNEL analysis. Importantly, these molecular changes were observed specifically in the thoracic segments but not in their counterparts obtained from lumbar sections. Conclusion Myocardial injury leads to time-dependent global changes in gene expression in the innervating ANS. Induction of inflammatory gene expression and loss of neuron cell viability in SG and DRG are potential novel mechanisms contributing to abnormal ANS function which can promote cardiac arrhythmia and pathological remodeling in myocardium.
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Affiliation(s)
- Chen Gao
- Division of Molecular Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Christoph Rau
- Division of Molecular Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Tatsuo Takamiya
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Yang Song
- Division of Molecular Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
| | - Yibin Wang
- Division of Molecular Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- * E-mail: (AM); (YW)
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, United States of America
- * E-mail: (AM); (YW)
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Witt CM, Bolona L, Kinney MO, Moir C, Ackerman MJ, Kapa S, Asirvatham SJ, McLeod CJ. Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia. Europace 2017; 19:1075-1083. [DOI: 10.1093/europace/eux011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 11/14/2022] Open
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Schwartz PJ, De Ferrari GM, Pugliese L. Cardiac sympathetic denervation 100years later: Jonnesco would have never believed it. Int J Cardiol 2017; 237:25-28. [PMID: 28318666 DOI: 10.1016/j.ijcard.2017.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/06/2017] [Indexed: 10/20/2022]
Abstract
One hundred years have elapsed since Thomas Jonnesco performed the first left cardiac sympathetic denervation (LCSD) in a patient with unmanageable angina pectoris and ventricular tachyarrhythmias, and the progress in the field has surpassed imagination. Here we will review the historic basis of cardiac sympathectomy for the management of life-threatening arrhythmias and will then discuss the often forgotten critical experimental studies that provided the rationale for the amazing growth of its role in clinical management. We will then mention the evolution in the surgical approaches, with their pros and cons. Similarly, we will address the existence of different views on the wisdom of starting with unilateral LCSD versus performing at outset bilateral CSD. The main results in the two diseases for which LCSD has already a definite role (namely the long QT syndrome and catecholaminergic polymorphic ventricular tachycardia) will be reviewed and discussed, touching also on the medico-legal implications descending from the clear efficacy of LCSD for these conditions. Finally, we will consider the potential value of LCSD for other clinical conditions and will close by mentioning a new randomized clinical trial in which LCSD is performed in patients with heart failure.
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Affiliation(s)
- Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Gaetano M De Ferrari
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigi Pugliese
- Unit of General Surgery 2, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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50
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Jang SY, Cho Y, Kim NK, Kim CY, Sohn J, Roh JH, Bae MH, Lee JH, Yang DH, Park HS, Chae SC, Oh TH, Kim GJ. Video-Assisted Thoracoscopic Left Cardiac Sympathetic Denervation in Patients with Hereditary Ventricular Arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:232-241. [PMID: 28012188 DOI: 10.1111/pace.13008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left cardiac sympathetic denervation (LCSD) has been underutilized in patients with hereditary ventricular arrhythmia syndromes such as congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The purpose of this study was to investigate the safety and efficacy of video-assisted thoracoscopic (VATS) LCSD in such patients. METHODS Fifteen patients (four men, 24.6 ± 10.5 years old) who underwent VATS-LCSD between November 2010 and January 2015 for hereditary ventricular arrhythmia syndromes at Kyungpook National University Hospital were enrolled in this study. The safety and efficacy of VATS-LCSD were evaluated by periprocedural epinephrine tests and assessing the development of complications and cardiac events during follow-up. RESULTS Fourteen patients with LQTS and one patient with CPVT underwent VATS-LCSD. Six and one patients developed ventricular tachyarrhythmia during preprocedural and postprocedural epinephrine test, respectively (P = 0.063). No serious complications such as Horner syndrome, pneumothorax, or bleeding developed after LCSD. Mean hospital stay after VATS-LCSD was 3.7 ± 1.5 days. During a mean follow-up of 927 ± 350 days, one LQTS patient and one CPVT patient, neither of whom manifested tachyarrhythmia during post-LCSD epinephrine test, developed torsades de pointes and syncope, respectively. The annual event rates of six patients who were symptomatic during the period preceding LCSD decreased from 0.97 to 0.19 events/year (P = 0.045). CONCLUSIONS VATS-LCSD was a safe, and effective procedure for patients with hereditary ventricular tachycardia syndrome, with no serious adverse events and with short hospital stay.
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Affiliation(s)
- Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.,Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Nam Kyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jihyun Sohn
- Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Jae-Hyung Roh
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.,Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
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