UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
Circulation. 2010 Jun 1;121(21):2255-62. doi: 10.1161/CIRCULATIONAHA.109.929703. Epub 2010 May 17.
Reducing sympathetic output to the heart from the neuraxis can protect against ventricular arrhythmias. The purpose of this study was to assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias in patients with structural heart disease.
Clinical data of 14 patients (25 to 75 years old, mean+/-SD of 54.2+/-16.6 years; 13 men) who underwent TEA, LCSD, or both to control ventricular tachycardia (VT) refractory to medical therapy and catheter ablation were reviewed. Twelve patients were in VT storm, and 2 experienced recurrent VT despite maximal medical therapy and catheter ablation procedures. The total number of therapies per patient before either procedure ranged from 5 to 202 (median of 24; 25th and 75th percentile, 5 and 56). Eight patients underwent TEA, and 9 underwent LCSD (3 patients had both procedures). No major procedural complications occurred. After initiation of TEA, 6 patients had a large (> or =80%) decrease in VT burden. After LCSD, 3 patients had no further VT, 2 had recurrent VT that either resolved within 24 hours or responded to catheter ablation, and 4 continued to have recurrent VT. Nine of 14 patients survived to hospital discharge (2 TEA alone, 3 TEA/LCSD combined, and 4 LCSD alone), 1 of the TEA alone patients underwent an urgent cardiac transplantation.
Initiation of TEA and LCSD in patients with refractory VT was associated with a subsequent decrease in arrhythmia burden in 6 (75%) of 8 patients (68% confidence interval 51% to 91%) and 5 (56%) of 9 patients (68% confidence interval 34% to 75%), respectively. These data suggest that TEA and LCSD may be effective additions to the management of refractory ventricular arrhythmias in structural heart disease when other treatment modalities have failed or may serve as a bridge to more definitive therapy.
减少来自中枢神经系统的心脏交感神经输出可以预防室性心律失常。本研究的目的是评估胸段硬膜外麻醉（TEA）和左侧心脏交感神经去神经支配（LCSD）在治疗结构性心脏病患者室性心律失常中的价值。
回顾了 14 例（25 至 75 岁，平均+/-标准差 54.2+/-16.6 岁；男性 13 例）患者的临床资料，这些患者因药物治疗和导管消融无效而接受 TEA、LCSD 或两者联合治疗以控制室性心动过速（VT）。12 例患者处于 VT 风暴中，2 例尽管接受了最大程度的药物治疗和导管消融，但仍出现反复发作的 VT。每位患者在任何一种治疗前的治疗次数从 5 次到 202 次不等（中位数为 24 次；25%和 75%分位数分别为 5 次和 56 次）。8 例患者接受 TEA，9 例患者接受 LCSD（3 例患者同时接受两种治疗）。没有发生重大的手术并发症。TEA 开始后，6 例患者 VT 负荷明显降低（>或=80%）。LCSD 后，3 例患者无进一步 VT，2 例复发性 VT 在 24 小时内缓解或对导管消融有反应，4 例患者持续有复发性 VT。14 例患者中有 9 例存活至出院（2 例仅接受 TEA，3 例 TEA/LCSD 联合治疗，4 例仅接受 LCSD 治疗），1 例仅接受 TEA 的患者紧急进行了心脏移植。
在难治性 VT 患者中开始 TEA 和 LCSD 治疗后，8 例患者中的 6 例（68%置信区间 51%至 91%）和 9 例患者中的 5 例（68%置信区间 34%至 75%）心律失常负荷随后降低。这些数据表明，在其他治疗方法失败时，TEA 和 LCSD 可能是结构性心脏病难治性室性心律失常治疗的有效补充，也可以作为更确定性治疗的桥梁。
