TY - JOUR
T1 - Cardiac sympathectomy for refractory ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy
AU - Assis, Fabrizio R.
AU - Krishnan, Aravind
AU - Zhou, Xun
AU - James, Cynthia A.
AU - Murray, Brittney
AU - Tichnell, Crystal
AU - Berger, Ronald
AU - Calkins, Hugh
AU - Tandri, Harikrishna
AU - Mandal, Kaushik
N1 - Funding Information:
The Johns Hopkins ARVD/C Program is supported by the Leyla Erkan Family Fund for ARVD Research, the Dr. Satish, Rupal, and Robin Shah ARVD Fund at Johns Hopkins , the Bolge Foundation , the Healing Hearts Foundation , the Campanella family, the Cohen family, the Patrick J. Harrison Family, the Peter French Memorial Foundation, and the Wilmerding Endowments.
Funding Information:
Dr Calkins and Dr Tandri receive support from Abbott . Dr Calkins receives research support from Boston Scientific . Ms Tichnell and Ms James receive salary support from this grant. The rest of the authors report no conflicts of interest.
Funding Information:
We acknowledge funding from the Dr Francis P Chiaramonte Private Foundation and Abbott . We are grateful to patients with arrhythmogenic right ventricular cardiomyopathy and their families who made this work possible.
Publisher Copyright:
© 2019 Heart Rhythm Society
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/7
Y1 - 2019/7
N2 - Background: The sympathetic nervous system plays an important role in arrhythmogenesis in arrhythmogenic right ventricular cardiomyopathy (ARVC). Sudden cardiac death commonly occurs during exertion, and β-blockers are associated with a reduction in arrhythmia burden. Bilateral cardiac sympathetic denervation (BCSD) has been shown to reduce implantable cardioverter-defibrillator (ICD) shocks in patients with structural heart disease and refractory ventricular tachycardia (VT); however, data in ARVC are sparse. Objective: The purpose of this study was to evaluate the role of BCSD in patients with ARVC and refractory VT. Methods: Consecutive patients with ARVC who underwent BCSD because of refractory VT were included. Number of ICD shocks, sustained VT episodes, VT storm, and antiarrhythmic therapy were assessed and compared before and after the intervention. VT-free survival rate, death, and heart transplantation were also evaluated. Results: Eight patients with ARVC (mean age 32 ± 20 years; 3 men [38%]) underwent sympathectomy for recurrent VT. All patients failed catheter ablation, and 50% had a desmosomal mutation identified. Procedural complications included neuropathic pain, paravertebral venous plexus injury, and pneumothorax. Over a mean follow-up of 1.9 ± 0.9 years, 5 patients (63%) had no VT recurrence. BCSD significantly reduced the number of ICD shocks or sustained VT compared with 1-year pre-BCSD (mean 12.6 ± 18.2 and median 6.5 [interquartile range 4.5–10.5] pre-BCSD vs 0.9 ± 1.4 and 0 [interquartile range 0–1.5] post-BCSD; P =.011). Most of the patients (88%) were on β-blocker therapy alone at the end of follow-up. One patient underwent heart transplantation because of heart failure, and no deaths occurred. Conclusion: BCSD may be an effective option for patients with ARVC and refractory ventricular arrhythmia who have failed conventional treatment modalities.
AB - Background: The sympathetic nervous system plays an important role in arrhythmogenesis in arrhythmogenic right ventricular cardiomyopathy (ARVC). Sudden cardiac death commonly occurs during exertion, and β-blockers are associated with a reduction in arrhythmia burden. Bilateral cardiac sympathetic denervation (BCSD) has been shown to reduce implantable cardioverter-defibrillator (ICD) shocks in patients with structural heart disease and refractory ventricular tachycardia (VT); however, data in ARVC are sparse. Objective: The purpose of this study was to evaluate the role of BCSD in patients with ARVC and refractory VT. Methods: Consecutive patients with ARVC who underwent BCSD because of refractory VT were included. Number of ICD shocks, sustained VT episodes, VT storm, and antiarrhythmic therapy were assessed and compared before and after the intervention. VT-free survival rate, death, and heart transplantation were also evaluated. Results: Eight patients with ARVC (mean age 32 ± 20 years; 3 men [38%]) underwent sympathectomy for recurrent VT. All patients failed catheter ablation, and 50% had a desmosomal mutation identified. Procedural complications included neuropathic pain, paravertebral venous plexus injury, and pneumothorax. Over a mean follow-up of 1.9 ± 0.9 years, 5 patients (63%) had no VT recurrence. BCSD significantly reduced the number of ICD shocks or sustained VT compared with 1-year pre-BCSD (mean 12.6 ± 18.2 and median 6.5 [interquartile range 4.5–10.5] pre-BCSD vs 0.9 ± 1.4 and 0 [interquartile range 0–1.5] post-BCSD; P =.011). Most of the patients (88%) were on β-blocker therapy alone at the end of follow-up. One patient underwent heart transplantation because of heart failure, and no deaths occurred. Conclusion: BCSD may be an effective option for patients with ARVC and refractory ventricular arrhythmia who have failed conventional treatment modalities.
KW - Arrhythmogenic right ventricular dysplasia/cardiomyopathy
KW - Cardiac sympathetic denervation
KW - ICD shocks
KW - Refractory ventricular tachycardia
KW - Sympathectomy
KW - Ventricular tachycardia recurrence
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U2 - 10.1016/j.hrthm.2019.01.019
DO - 10.1016/j.hrthm.2019.01.019
M3 - Article
C2 - 30677492
AN - SCOPUS:85067333146
SN - 1547-5271
VL - 16
SP - 1003
EP - 1010
JO - Heart Rhythm
JF - Heart Rhythm
IS - 7
ER -