Department of Cardiology, Advance Cardiac Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Cardiology, Holy Family Hospital, Mumbai, India.
J Cardiovasc Electrophysiol. 2021 Apr;32(4):1065-1074. doi: 10.1111/jce.14947. Epub 2021 Feb 25.
Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long-term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA.
We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT.
A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow-up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter-defibrillator (ICD) or external defibrillator shocks post-CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint.
The current retrospective analysis re-emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.
心脏去交感神经支配（CSD）是结构性心脏病（SHD）和室性心动过速（VT）患者的一种有用的治疗选择，这些患者对标准抗心律失常药物（AAD）治疗或导管消融（CA）无反应。在这项研究中，我们试图回顾性分析CSD 在难治性 VT 和/或 VT 风暴患者中的长期结果，这些患者大多数在接受 CA 之前就进行了 CSD。
我们纳入了 2010 年至 2019 年因难治性 VT 接受 CBD 的连续 SHD 患者。CSD 的完全反应定义为 ICD 治疗 VT 的电击频率降低大于 75%。
共纳入 65 例患者（50 例男性，15 例女性）。VT 基质为缺血性心脏病（IHD）的有 30 例（46.2%），其余 35 例（53.8%）为其他非缺血性病因。平均随访时间为 27±24 个月。47 例（72.3%）患者对 CSD 有完全反应。CSD 后植入式心脏复律除颤器（ICD）或体外除颤器电击次数显著减少（24±37 次 vs. 2±4 次，p<0.01）。2 年时 ICD 电击或死亡的复合终点无事件生存率为 51.5%。纽约心脏协会（NYHA）心功能分级（III 级和 IV 级）是唯一与该复合终点相关的参数。
目前的回顾性分析再次强调了外科 CSD 的作用，并探讨了其在治疗难治性 VT 或 VT 风暴患者时在 CA 之前的作用。
