UCLA Cardiac Arrhythmia Center and Neurocardiology Center of Excellence UCLA Health System David Geffen School of Medicine at UCLA, Los Angeles, CA.
UCLA Department of Anesthesiology, UCLA Health System, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Am Heart Assoc. 2017 Oct 27;6(11):e007080. doi: 10.1161/JAHA.117.007080.
Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (TEA), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (VT) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with TEA in the management of VT storm to determine its optimal therapeutic use.
Data for 11 patients in whom TEA was instituted for VT storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant VT in 7 (64%), with polymorphic VT in 3 (27%) and monomorphic VT in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to TEA; 4 of the complete responders had incessant VT. All 4 patients with a documented response to deep sedation demonstrated a complete response to TEA.
More than half of the patients with VT storm in our series responded to TEA. TEA may be effective and should be considered as a therapeutic option in patients with VT storm, especially incessant VT, who are refractory to initial management. Improvement in VT burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating VT and predict a positive response to TEA.
新型疗法旨在调节自主神经系统，包括胸段硬膜外麻醉（TEA），在小病例系列中已被证明对治疗药物难治性室性心动过速（VT）风暴有益。然而，目前尚不清楚何时应考虑这些方法。我们回顾了 TEA 在 VT 风暴管理中的多中心经验，以确定其最佳治疗用途。
回顾了 2005 年 7 月至 2016 年 3 月期间因 VT 风暴而接受 TEA 治疗的 11 名患者的数据，以确定其临床特征、结局和管理作用。临床表现为 7 例（64%）持续性 VT，3 例（27%）多形性 VT，8 例（73%）单形性 VT。基础疾病为非缺血性心肌病 5 例（45%），缺血性心肌病 3 例（27%），肥厚型心肌病、Brugada 综合征和心脏脂肪瘤各 1 例（9%）。5 例（45%）对 TEA 完全有效，1 例（9%）部分有效；完全反应者中 4 例为持续性 VT。所有 4 例深镇静有记录反应的患者均对 TEA 有完全反应。
我们系列中的 VT 风暴患者中有一半以上对 TEA 有反应。TEA 可能有效，应作为 VT 风暴患者的治疗选择，尤其是对初始治疗有反应的持续性 VT 患者。深镇静后 VT 负荷的改善可能表明交感神经兴奋在持续性 VT 中起关键作用，并预测对 TEA 的阳性反应。
