Duke Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
Duke Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA.
JACC Clin Electrophysiol. 2020 May;6(5):562-571. doi: 10.1016/j.jacep.2019.12.017. Epub 2020 Feb 26.
This study sought to describe our institutional experience with establishing a neurocardiology service in an attempt to provide autonomic modulation as a treatment for ventricular arrhythmias (VAs).
Treatment-refractory VAs are commonly driven and exacerbated by heightened sympathetic tone.
Among patients referred to the neurocardiology service (August 2016 to December 2018), we performed ultrasound-based, bilateral, temporary stellate ganglion blockade (SGB) in 20 consecutive patients. We analyzed outcomes of interest including sustained VA or VA requiring defibrillation in the 24 and 48 h before and 24 and 48 h after SGB.
The majority of patients were men (n = 19, 95%), with a mean age of 58 ± 14 years. At the time of SGB, 10 (50%) were on inotropic support and 9 (45%) were on mechanical circulatory support. Besides 1 case of hoarseness, there were no apparent procedural complications. SGB was associated with a reduction in the number of VA episodes from the 24 h before (median 5.5 [interquartile range (IQR): 2.0 to 15.8]) to 24 h after SGB (median 0 [IQR: 0 to 3.8]) (p < 0.001). The number of defibrillation events decreased from 2.5 (IQR: 0 to 10.3) to 0 (IQR: 0 to 2.5) (p = 0.002). Similar findings were observed over the 48-h period before and after the SGB. Overall, 9 of 20 (45%) patients had a complete response with no recurrence of ventricular tachycardia (VT) or ventricular fibrillation (VF) for 48 h after SGB. Four (20%) patients had no recurrent VT or VF following SGB through discharge. Similar response rates were observed in those with ischemic (median 6 [IQR: 1.8 to 18.8] to 0.5 [IQR: 0 to 5.3] events; p = 0.031) and nonischemic (median 3.5 [IQR: 1.8 to 6.8] to 0 [IQR: 0 to 1.3] events; p = 0.012) cardiomyopathy.
Minimally invasive, ultrasound-guided bilateral SGB appears safe and provides substantial reduction in VA burden with approximately 1 in 2 patients exhibiting complete suppression of VT or VF for 48 h.
本研究旨在描述我们在建立神经心脏病学服务方面的经验，试图提供自主调节作为治疗室性心律失常（VA）的方法。
治疗抵抗性 VA 通常由交感神经张力升高引起和加重。
在 2016 年 8 月至 2018 年 12 月期间转至神经心脏病学服务的患者中，我们对 20 名连续患者进行了基于超声的双侧、暂时性星状神经节阻滞（SGB）。我们分析了感兴趣的结局，包括 SGB 前 24 小时和 48 小时、SGB 后 24 小时和 48 小时持续 VA 或需要除颤的 VA。
大多数患者为男性（n=19，95%），平均年龄 58±14 岁。在 SGB 时，10 名（50%）患者接受了正性肌力支持，9 名（45%）患者接受了机械循环支持。除了 1 例声音嘶哑外，没有明显的手术并发症。SGB 与 VA 发作次数减少相关，从 SGB 前 24 小时的中位数 5.5（四分位距：2.0 至 15.8）减少到 SGB 后 24 小时的中位数 0（四分位距：0 至 3.8）（p<0.001）。除颤事件的次数从 2.5（四分位距：0 至 10.3）减少到 0（四分位距：0 至 2.5）（p=0.002）。在 SGB 前后 48 小时内观察到类似的结果。总体而言，20 名患者中有 9 名（45%）在 SGB 后 48 小时内完全没有室性心动过速（VT）或室颤（VF）复发。4 名（20%）患者在 SGB 后出院时没有复发性 VT 或 VF。在缺血性（中位数 6 [四分位距：1.8 至 18.8]至 0.5 [四分位距：0 至 5.3]事件；p=0.031）和非缺血性（中位数 3.5 [四分位距：1.8 至 6.8]至 0 [四分位距：0 至 1.3]事件；p=0.012）心肌病患者中观察到相似的反应率。
微创、超声引导双侧 SGB 似乎安全，并提供 VA 负担的显著减少，大约每 2 名患者中就有 1 名在 SGB 后 48 小时内完全抑制 VT 或 VF。
