UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
Heart Rhythm. 2018 Aug;15(8):1252-1260. doi: 10.1016/j.hrthm.2018.02.015. Epub 2018 Feb 14.
Ventricular arrhythmias are responsible for hundreds of thousands of deaths every year. Catheter ablation of ventricular tachycardia (VT) is an essential component of the management of these life-threatening arrhythmias. However, in many patients, despite medical and interventional therapy, VT recurs. Furthermore, some VT substrates (mid-myocardial, left ventricular summit, and intraseptal) are not easily targeted because of limitations of currently available technology. In certain clinical settings, ventricular fibrillation (VF) episodes that have premature ventricular contraction triggers can also be targeted with catheter ablation. However, in most patients there is no clear VF trigger to target, and therefore polymorphic VT or VF cannot be adequately treated with catheter ablation. The autonomic nervous system plays a crucial role in all aspects of ventricular arrhythmias, yet interventions specific to the cardiac neuronal axis have been largely underutilized. This underutilization has been most pronounced in patients with structural heart disease. However, there is a growing body of literature on the physiology and pathophysiology of cardiac neural control and the benefits of neuromodulation to treat refractory ventricular arrhythmias in these patients. We present case-based examples of neuromodulatory interventions currently available and a review of the literature supporting their use.
室性心律失常每年导致数十万人死亡。导管消融室性心动过速（VT）是这些危及生命的心律失常治疗的重要组成部分。然而，在许多患者中，尽管进行了药物和介入治疗，VT 仍会复发。此外，由于现有技术的限制，某些 VT 底物（中膜、左心室顶部和间隔内）不易被靶向。在某些临床情况下，也可以对具有室性期前收缩触发的心室颤动（VF）发作进行导管消融。然而，在大多数患者中，没有明确的 VF 触发点可被靶向，因此多形性 VT 或 VF 不能用导管消融充分治疗。自主神经系统在室性心律失常的各个方面都起着至关重要的作用，但针对心脏神经元轴的干预措施在很大程度上未被充分利用。这种未被充分利用在结构性心脏病患者中最为明显。然而，关于心脏神经控制的生理学和病理生理学以及神经调节治疗这些患者难治性室性心律失常的益处的文献越来越多。我们提供了目前可用的神经调节干预措施的基于案例的示例，并回顾了支持其使用的文献。
