Saenz Luis Carlos, Corrales Federico Malavassi, Bautista William, Traina Mahmoud, Meymandi Sheba, Rodriguez Diego A, Tellez Luis J, Vaseghi Marmar, Garcia Fermin, Shivkumar Kalyanam, Bradfield Jason S
International Arrhythmia Center, Cardioinfantil Foundation, Bogota, Colombia.
Olive View-UCLA Center of Excellence for Chagas Disease, Sylmar, California.
Heart Rhythm. 2016 Jul;13(7):1388-94. doi: 10.1016/j.hrthm.2016.03.014. Epub 2016 Mar 9.
Autonomic modulation is a valuable therapeutic option for the management of ventricular arrhythmias. Bilateral cardiac sympathetic denervation (BCSD) has shown promising results in the acute, intermediate, and long-term management of polymorphic and monomorphic ventricular tachycardia (VT) in patients with structural heart disease. Cardiomyopathy (CM) due to Chagas disease (CD), and associated VT, is thought to be in part due to autonomic neuronal destruction and dysfunction.
The purpose of this study was to assess whether BCSD is a safe and effective treatment modality in patients with CD and VT storm or refractory VT.
A retrospective analysis of data from patients with chagasic CM who underwent BCSD between 2009 and 2015 at 2 international centers was performed.
Of 75 patients who underwent BCSD for VT storm or refractory VT in the setting of CM, 7 (9.3%) patients had CD as the etiology of CM. All patients had monomorphic VT. Median follow-up was 7 months (range 1-46 months). All patients either underwent previous unsuccessful catheter ablation or were not candidates for ablation. The median number of implantable cardioverter-defibrillator (ICD) shocks 1 month before BCSD was 4 (range 2-30) and decreased to 0 (range 0-2) during available follow-up after BCSD. When antitachycardia pacing therapies were included in the analysis, the median number of ICD therapies (shocks + antitachycardia pacing) still decreased to 1 (range 0-3).
In patients with chagasic CM presenting with refractory monomorphic VT, early evidence suggests that BCSD reduces appropriate ICD therapy and may represent a valuable treatment option.
自主神经调节是治疗室性心律失常的一种有价值的治疗选择。双侧心脏交感神经去神经支配（BCSD）在结构性心脏病患者的多形性和单形性室性心动过速（VT）的急性、中期和长期管理中已显示出有前景的结果。恰加斯病（CD）所致的心肌病（CM）以及相关的VT，被认为部分是由于自主神经神经元破坏和功能障碍所致。
本研究的目的是评估BCSD在患有CD和VT风暴或难治性VT的患者中是否是一种安全有效的治疗方式。
对2009年至2015年期间在2个国际中心接受BCSD的恰加斯病CM患者的数据进行回顾性分析。
在75例因CM合并VT风暴或难治性VT而接受BCSD的患者中，7例（9.3%）患者的CM病因是CD。所有患者均为单形性VT。中位随访时间为7个月（范围1 - 46个月）。所有患者此前均接受过不成功的导管消融或不适合进行消融。BCSD前1个月植入式心律转复除颤器（ICD）电击的中位数为4次（范围2 - 30次），在BCSD后的可用随访期间降至0次（范围0 - 2次）。当分析中纳入抗心动过速起搏治疗时，ICD治疗（电击 + 抗心动过速起搏）的中位数仍降至1次（范围0 - 3次）。
在患有难治性单形性VT的恰加斯病CM患者中，早期证据表明BCSD可减少ICD的适当治疗，可能是一种有价值的治疗选择。
