Gurau Andrei, Perdomo Dianela, Khan Hamza, Melinosky Kelsey, Chudnovets Anna, Blum Jacob, Kutmah Mahmoud, Yang Victor, Leng Albert, Menta Arjun, Zhao Xiyu, Yamauchi Suguru, Rodgers Kristen, Ecoff Kathryn, Bush Errol, Barth Andreas S, Brock Malcolm, Bosmans Frank, Ha Jinny S
Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
Valley Health System General Surgery Residency Program, Las Vegas, Nev.
JTCVS Open. 2024 Dec 12;23:120-127. doi: 10.1016/j.xjon.2024.11.020. eCollection 2025 Feb.
Although cardiac sympathetic denervation (CSD) effectively manages refractory ventricular tachyarrhythmias (RVTs) in long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia, the link between dysautonomia and RVT from broader etiologies is understudied. We hypothesized that dysautonomia is linked to RVT regardless of etiology in patients requiring CSD. We aimed to determine whether these patients have a high burden of dysautonomia symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31).
COMPASS-31 surveys were administered to 37 patients with RVT who underwent CSD and 37 matched healthy controls. COMPASS-31 scores were compared using Mann-Whitney tests. Comparisons were made between patients with and without structural heart disease, and multivariable regression identified predictors for COMPASS-31 scores and CSD response.
Common operative indications were idiopathic ventricular arrhythmias (49%) and arrhythmogenic right ventricular cardiomyopathy (30%). Patients with RVT had significantly greater COMPASS-31 scores (median 25.3) compared with control patients (median 8.6, < .001), with greater scores in the gastrointestinal, secretomotor, orthostasis, pupillomotor, and vasomotor domains. Sensitivity analysis confirmed these findings, showing significantly greater COMPASS-31 scores in cases versus controls (estimate: 14.5; 95% confidence interval, 9.2-19.8, < .001). No differences were found between patients with and without structural heart disease, and no predictors for COMPASS-31 score were identified. One year post-CSD, 78.4% of patients remained free of implantable cardioverter-defibrillator shocks.
Dysautonomia symptoms are significantly associated with RVT requiring CSD, regardless of underlying etiology. This association, in the context of CSD efficacy in RVT across structural and nonstructural etiologies, highlights autonomic dysfunction as a common pathophysiologic link warranting further investigation.
虽然心脏交感神经去神经支配术（CSD）能有效治疗长QT综合征和儿茶酚胺能多形性室性心动过速中的难治性室性心律失常（RVT），但自主神经功能障碍与更广泛病因导致的RVT之间的联系尚未得到充分研究。我们假设，在需要CSD的患者中，无论病因如何，自主神经功能障碍都与RVT有关。我们旨在使用综合自主神经症状评分-31（COMPASS-31）来确定这些患者是否有较高的自主神经功能障碍症状负担。
对37例接受CSD的RVT患者和37例匹配的健康对照者进行COMPASS-31调查。使用曼-惠特尼检验比较COMPASS-31评分。对有和无结构性心脏病的患者进行比较，并通过多变量回归确定COMPASS-31评分和CSD反应的预测因素。
常见的手术指征为特发性室性心律失常（49%）和致心律失常性右室心肌病（30%）。与对照患者（中位数8.6，<0.001）相比，RVT患者的COMPASS-31评分显著更高（中位数25.3），在胃肠道、分泌运动、直立位、瞳孔运动和血管运动领域的评分更高。敏感性分析证实了这些发现，显示病例组的COMPASS-31评分显著高于对照组（估计值：14.5；95%置信区间，9.2-19.8，<0.001）。有和无结构性心脏病的患者之间未发现差异，也未确定COMPASS-31评分的预测因素。CSD术后一年，78.4%的患者未发生植入式心律转复除颤器电击。
无论潜在病因如何，自主神经功能障碍症状与需要CSD的RVT显著相关。在CSD对结构性和非结构性病因的RVT均有效的情况下，这种关联突出了自主神经功能障碍作为一个共同的病理生理联系，值得进一步研究。
