Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Lübeck, Germany.
Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Clin Res Cardiol. 2021 Jan;110(1):21-28. doi: 10.1007/s00392-020-01643-8. Epub 2020 Apr 23.
Cardiac sympathetic denervation (CSD) is an effective therapy for selected patients with drug refractory ventricular arrhythmias (VA). Data about the role of CSD in patients with structural heart disease and VAs are sparse. We herein present our experience of CSD in patients with nonischemic cardiomyopathy and VAs despite prior ablation procedure and/or antiarrhythmic drug (AAD) therapy.
A total of ten patients (mean age 61.6 ± 19.6, mean LVEF 29.5 ± 12.1%) with nonischemic dilated cardiomyopathy (NICM) (n = 9) and hypertrophic cardiomyopathy (HCM) (n = 1) underwent CSD (left sided in six and bilateral in four patients) due to refractory VA despite multiple AADs (mean number of AADs was 1.6 ± 0.7) and prior VT ablation (mean number of procedures per patient was 1.5 ± 1.3).
Mean follow-up was 10.1 ± 6.9 months. The median number of VA and ICD shocks decreased significantly from 9.0 and 2.5 episodes 6 months prior to CSD to 0 and 0 episodes within 6 months after CSD (p = 0.012 and p = 0.011). Five patients remained free from sustained VA recurrences. Two patients experienced single ICD shock due to a polymorphic VT (triggered by severe hypokalemia in one patient) and one patient a single shock due to monomorphic VT. One patient had five episodes of slow VT under amiodarone therapy (three of them terminated by antitachycardia pacing) and underwent endo- epicardial re-ablation. Two patients died 1 month after CSD. One of them due to electrical storm and cardiogenic shock and the second one due to refractory cardiogenic shock, without recurrence of VAs though. No major complications of CSD occurred. No patient suffered from Horner syndrome.
In this study, CSD was effective for treatment of VAs in patients with structural heart disease refractory to antiarrhythmic drugs and catheter ablation. Further larger studies are required to confirm these findings.
心脏去交感神经术（CSD）是治疗药物难治性室性心律失常（VA）的有效方法。关于 CSD 在结构性心脏病和 VA 患者中的作用的数据很少。本文报告了我们在结构性心脏病和 VA 患者中应用 CSD 的经验，这些患者在接受消融术和/或抗心律失常药物（AAD）治疗后仍存在 VA。
共有 10 名患者（平均年龄 61.6±19.6 岁，平均 LVEF 29.5±12.1%）接受了 CSD 治疗，这些患者患有非缺血性扩张型心肌病（NICM）（n=9）和肥厚型心肌病（HCM）（n=1），尽管接受了多种 AAD（平均 AAD 数量为 1.6±0.7）和先前的 VT 消融术（平均每位患者消融术数量为 1.5±1.3），仍存在药物难治性 VA。CSD 为左侧 6 例，双侧 4 例。
平均随访时间为 10.1±6.9 个月。CSD 前 6 个月 VA 和 ICD 电击的中位数次数从 9.0 次和 2.5 次明显减少到 CSD 后 6 个月的 0 次和 0 次（p=0.012 和 p=0.011）。5 名患者无持续性 VA 复发。2 名患者因多形性 VT（1 名患者因严重低钾血症引起）和 1 名患者因单形性 VT 各经历 1 次 ICD 电击。1 名患者在胺碘酮治疗下发生 5 次缓慢 VT（其中 3 次由抗心动过速起搏终止），并接受了心内膜心外膜再消融术。2 名患者在 CSD 后 1 个月死亡。其中 1 例死于电风暴和心源性休克，另 1 例死于难治性心源性休克，但 VA 无复发。CSD 无严重并发症发生。无患者出现霍纳综合征。
在这项研究中，CSD 对结构性心脏病患者药物和导管消融治疗无效的 VA 治疗有效。需要进一步的大型研究来证实这些发现。
