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Martinek M, Manninger M, Schönbauer R, Scherr D, Schukro C, Pürerfellner H, Petzl A, Strohmer B, Derndorfer M, Bisping E, Stühlinger M, Fiedler L. Expert consensus on acute management of ventricular arrhythmias - VT network Austria. IJC HEART & VASCULATURE 2021; 34:100760. [PMID: 33869728 PMCID: PMC8047164 DOI: 10.1016/j.ijcha.2021.100760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/11/2022]
Abstract
The Arrhythmia Working Group of the Austrian Society of Cardiology (ÖKG) has set the goal of systematically structuring and organizing the acute care of patients with ventricular arrhythmias (VA), i.e. ventricular tachycardia (VT) or ventricular fibrillation (VF) in Austria. Within a consensus paper, national recommendations on the basic diagnostic work-up of VA (12-lead ECG, medical history, family history, laboratory analyses, echocardiography, search for reversible causes, ICD interrogation), as well as further medical treatment and therapeutic measures (indication of coronary angiography, ablation therapy) are established. Since acute ablation of VT is indicated in the current ESC guidelines as a class IB indication for scar-associated incessant VT or electrical storm (ES; ≥ 3 ICD therapies in 24 h) as well as for ischemic cardiomyopathy (iCMP) with recurrent ICD shocks, organizational measures must be taken to ensure that these guidelines can be implemented. Therefore, a VT network will be established covering all areas in Austria, consisting of primary and secondary VT centers. Organizational aspects of an acute VT network are defined and should subsequently be implemented by the participating hospitals. All electrophysiologic centers in Austria that deal with VT ablation are to be integrated into the network in the medium-term. Centers that co-operate in the network are divided into primary and secondary VT centers according to predefined criteria.
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Affiliation(s)
- M. Martinek
- Ordensklinikum Linz Elisabethinen, Interne 2 mit Kardiologie, Angiologie und Intensivmedizin, Fadingerstrasse 1, 4020 Linz, Austria
- Universitätsklinikum St. Pölten, Interne 3 – Kardiologie, Dunant-Platz 1, 3100 St. Pölten, Austria
| | - M. Manninger
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin – Klinische Abteilung für Kardiologie, Auenbruggerplatz 15, 8036 Graz, Austria
| | - R. Schönbauer
- Universitätsklinik für Innere Medizin II – Klinische Abteilung für Kardiologie, Währinger Gürtel 18-20, 1090 Wien, Austria
| | - D. Scherr
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin – Klinische Abteilung für Kardiologie, Auenbruggerplatz 15, 8036 Graz, Austria
| | - C. Schukro
- Universitätsklinik für Innere Medizin II – Klinische Abteilung für Kardiologie, Währinger Gürtel 18-20, 1090 Wien, Austria
| | - H. Pürerfellner
- Ordensklinikum Linz Elisabethinen, Interne 2 mit Kardiologie, Angiologie und Intensivmedizin, Fadingerstrasse 1, 4020 Linz, Austria
| | - A. Petzl
- Universitätsklinikum St. Pölten, Interne 3 – Kardiologie, Dunant-Platz 1, 3100 St. Pölten, Austria
| | - B. Strohmer
- Universitätsklinik für Innere Medizin II – Paracelsus Medizinische Privatuniversität, Müllner Hauptstrasse 48, 5020 Salzburg, Austria
| | - M. Derndorfer
- Ordensklinikum Linz Elisabethinen, Interne 2 mit Kardiologie, Angiologie und Intensivmedizin, Fadingerstrasse 1, 4020 Linz, Austria
| | - E. Bisping
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin – Klinische Abteilung für Kardiologie, Auenbruggerplatz 15, 8036 Graz, Austria
| | - M. Stühlinger
- Universitätsklinik für Innere Medizin III – Kardiologie und Angiologie, Anichstrasse 35, 6020 Innsbruck, Austria
| | - L. Fiedler
- Landesklinikum Wiener Neustadt, Abteilung für Innere Medizin, Kardiologie und Nephrologie, Corvinusring 3-5, 2700 Wiener Neustadt, Austria
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Bains K, Janfaza D, Flaherty D, Zeballos J, Halawa A, Tedrow U, Vlassakov K. Sympathetic Blockade for the Management of Refractory Ventricular Tachycardia: A Case Report. A A Pract 2021; 15:e01456. [PMID: 33882033 DOI: 10.1213/xaa.0000000000001456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 64-year-old man with a history of nonischemic cardiomyopathy (NICM) presented with electrical storm (ES). Episodes of ventricular tachycardia (VT) persisted despite endocardial catheter ablations and exhaustive pharmacotherapy. We used alternating regional anesthesia techniques, left stellate ganglion block, and proximal intercostal block to reduce sympathetic input to the heart, resulting in a significant decrease in VT burden. By using alternating catheter locations, we were able to maintain continuous sympathetic blockade for 31 days and bridge the patient to a successful orthotopic heart transplant.
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Affiliation(s)
- Kavin Bains
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - David Janfaza
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Devon Flaherty
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Jose Zeballos
- From the Department of Anesthesiology, Perioperative and Pain Medicine
| | - Ahmad Halawa
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Usha Tedrow
- Department of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kamen Vlassakov
- From the Department of Anesthesiology, Perioperative and Pain Medicine
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Roach C, Tainter CR, Sell RE, Wardi G. Resuscitating Resuscitation: Advanced Therapies for Resistant Ventricular Dysrhythmias. J Emerg Med 2020; 60:331-341. [PMID: 33339645 DOI: 10.1016/j.jemermed.2020.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND More than 640,000 combined in-hospital and out-of-hospital cardiac arrests occur annually in the United States. However, survival rates and meaningful neurologic recovery remain poor. Although "shockable" rhythms (i.e., ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT)) have the best outcomes, many of these ventricular dysrhythmias fail to return to a perfusing rhythm (resistant VF/VT), or recur shortly after they are resolved (recurrent VF/VT). OBJECTIVE This review discusses 4 emerging therapies in the emergency department for treating these resistant or recurrent ventricular dysrhythmias: beta-blocker therapy, dual simultaneous external defibrillation, stellate ganglion blockade, and extracorporeal cardiopulmonary resuscitation. We discuss the underlying physiology of each therapy, review relevant literature, describe when these approaches should be considered, and provide evidence-based recommendations for these techniques. DISCUSSION Esmolol may mitigate some of epinephrine's negative effects when used during resuscitation, improving both postresuscitation cardiac function and long-term survival. Dual simultaneous external defibrillation targets the region of the heart where ventricular fibrillation typically resumes and may apply a more efficient defibrillation across the heart, leading to higher rates of successful defibrillation. Stellate ganglion blocks, recently described in the emergency medicine literature, have been used to treat patients with recurrent VF/VT, resulting in significant dysrhythmia suppression. Finally, extracorporeal cardiopulmonary resuscitation is used to provide cardiopulmonary support while clinicians correct reversible causes of arrest, potentially resulting in improved survival and good neurologic functional outcomes. CONCLUSION These emerging therapies do not represent standard practice; however, they may be considered in the appropriate clinical scenario when standard therapies are exhausted without success.
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Affiliation(s)
- Colin Roach
- Department of Emergency Medicine, University of California, San Diego, San Diego, California
| | - Christopher R Tainter
- Department of Anesthesiology, Division of Critical Care, University of California, San Diego, San Diego, California
| | - Rebecca E Sell
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, California
| | - Gabriel Wardi
- Department of Emergency Medicine, University of California, San Diego, San Diego, California; Division of Pulmonary, Critical Care, and Sleep Medicine, University of California, San Diego, San Diego, California
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Burra V, Simha PP, Manjunath N. Role of percutaneous left stellate ganglion blockade (LSGB) as a rescue therapy in refractory ventricular tachycardia. Indian J Anaesth 2020; 64:812-814. [PMID: 33162582 PMCID: PMC7641084 DOI: 10.4103/ija.ija_387_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/06/2020] [Accepted: 05/17/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Vijitha Burra
- Department of Cardiac Anaesthesia, SRM Institute of Medical Sciences Hospital, Chennai, Tamil Nadu, India
| | - Parimala Prasanna Simha
- Department of Cardiac Anaesthesia, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - N Manjunath
- Department of Cardiac Anaesthesia, SRM Institute of Medical Sciences Hospital, Chennai, Tamil Nadu, India
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Wang Y, Yu L, Po SS. Ablation of Neuroaxial in Patients with Ventricular Tachycardia. Card Electrophysiol Clin 2020; 11:625-634. [PMID: 31706470 DOI: 10.1016/j.ccep.2019.08.001] [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] [Indexed: 12/19/2022]
Abstract
Ventricular tachycardia (VT) remains a common cause of sudden cardiac death. It is widely accepted that VTs are strongly associated with autonomic imbalance with reduced vagal and increased sympathetic activities. Pharmacologic therapy remains the first-line therapy, but antiarrhythmic agents may not be effective or carry significant side effects. Sympathetic denervation is an emerging therapy to prevent or treat VTs by rebalancing the sympathetic and parasympathetic activity. This article focuses on the role of sympathetic activation in VT, and the mapping and ablation of sympathetic nervous system in patients with VT.
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Affiliation(s)
- Yuhong Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, Hubei, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Cardiovascular Research Institute, Wuhan University, Hubei Key Laboratory of Cardiology, No. 9 ZhangZhiDong Street, Wuchang District, Wuhan, Hubei, China
| | - Sunny S Po
- Department of Medicine, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Spartalis M, Spartalis E, Tzatzaki E, Tsilimigras DI, Moris D, Kontogiannis C, Livanis E, Iliopoulos DC, Voudris V, Theodorakis GN. Novel approaches for the treatment of ventricular tachycardia. World J Cardiol 2018; 10:52-59. [PMID: 30079151 PMCID: PMC6068734 DOI: 10.4330/wjc.v10.i7.52] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/24/2018] [Accepted: 06/27/2018] [Indexed: 02/06/2023] Open
Abstract
Ventricular tachycardia (VT) is a crucial cause of sudden cardiac death (SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to life-threatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of research. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.
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Affiliation(s)
- Michael Spartalis
- ESC Working Group on Cardiac Cellular Electrophysiology, Sophia Antipolis Cedex 06903, France
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Eleftherios Spartalis
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Eleni Tzatzaki
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Diamantis I Tsilimigras
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Demetrios Moris
- Department of Surgery, Duke University, Durham, NC 27710, United States
| | - Christos Kontogiannis
- Department of Clinical Therapeutics, “Alexandra” Hospital, University of Athens, Athens 11528, Greece
| | - Efthimios Livanis
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
| | - Dimitrios C Iliopoulos
- Laboratory of Experimental Surgery and Surgical Research, University of Athens Medical School, Athens 11527, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens 17674, Greece
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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: 67] [Impact Index Per Article: 9.6] [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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