Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias

Marmar Vaseghi, Parag Barwad, Federico J. Malavassi Corrales, Harikrishna Tandri, Nilesh Mathuria, Rushil Shah, Julie M. Sorg, Jean Gima, Kaushik Mandal, Luis C. Sàenz Morales, Yash Lokhandwala, Kalyanam Shivkumar

Research output: Research - peer-reviewArticle

Abstract

BACKGROUND: Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT).

OBJECTIVES: This study assessed the value of CSD and the characteristics associated with outcomes in this population.

METHODS: Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD.

RESULTS: Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p < 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up.

CONCLUSIONS: CSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.

LanguageEnglish (US)
Pages3070-3080
Number of pages11
JournalJournal of the American College of Cardiology
Volume69
Issue number25
DOIs
StatePublished - Jun 27 2017

Fingerprint

Sympathectomy
Tachycardia
Cardiac Arrhythmias
Implantable Defibrillators
Shock
Recurrence
Heart Diseases
Heart Failure
Mortality
Kaplan-Meier Estimate
Heart Transplantation
Proportional Hazards Models
Transplantation
Transplants
Population

Keywords

  • antiarrhythmic drugs
  • autonomic nervous system
  • functional class
  • implantable cardioverter-defibrillator
  • orthotopic heart transplantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Vaseghi, M., Barwad, P., Malavassi Corrales, F. J., Tandri, H., Mathuria, N., Shah, R., ... Shivkumar, K. (2017). Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. Journal of the American College of Cardiology, 69(25), 3070-3080. DOI: 10.1016/j.jacc.2017.04.035

Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. / Vaseghi, Marmar; Barwad, Parag; Malavassi Corrales, Federico J.; Tandri, Harikrishna; Mathuria, Nilesh; Shah, Rushil; Sorg, Julie M.; Gima, Jean; Mandal, Kaushik; Sàenz Morales, Luis C.; Lokhandwala, Yash; Shivkumar, Kalyanam.

In: Journal of the American College of Cardiology, Vol. 69, No. 25, 27.06.2017, p. 3070-3080.

Research output: Research - peer-reviewArticle

Vaseghi, M, Barwad, P, Malavassi Corrales, FJ, Tandri, H, Mathuria, N, Shah, R, Sorg, JM, Gima, J, Mandal, K, Sàenz Morales, LC, Lokhandwala, Y & Shivkumar, K 2017, 'Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias' Journal of the American College of Cardiology, vol 69, no. 25, pp. 3070-3080. DOI: 10.1016/j.jacc.2017.04.035
Vaseghi M, Barwad P, Malavassi Corrales FJ, Tandri H, Mathuria N, Shah R et al. Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. Journal of the American College of Cardiology. 2017 Jun 27;69(25):3070-3080. Available from, DOI: 10.1016/j.jacc.2017.04.035
Vaseghi, Marmar ; Barwad, Parag ; Malavassi Corrales, Federico J. ; Tandri, Harikrishna ; Mathuria, Nilesh ; Shah, Rushil ; Sorg, Julie M. ; Gima, Jean ; Mandal, Kaushik ; Sàenz Morales, Luis C. ; Lokhandwala, Yash ; Shivkumar, Kalyanam. / Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. In: Journal of the American College of Cardiology. 2017 ; Vol. 69, No. 25. pp. 3070-3080
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AU - Malavassi Corrales,Federico J.

AU - Tandri,Harikrishna

AU - Mathuria,Nilesh

AU - Shah,Rushil

AU - Sorg,Julie M.

AU - Gima,Jean

AU - Mandal,Kaushik

AU - Sàenz Morales,Luis C.

AU - Lokhandwala,Yash

AU - Shivkumar,Kalyanam

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N2 - BACKGROUND: Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of implantable cardioverter-defibrillator (ICD) shocks in small series of patients with structural heart disease (SHD) and recurrent ventricular tachyarrhythmias (VT).OBJECTIVES: This study assessed the value of CSD and the characteristics associated with outcomes in this population.METHODS: Patients with SHD who underwent CSD for refractory VT or VT storm at 5 international centers were analyzed by the International Cardiac Sympathetic Denervation Collaborative Group. Kaplan-Meier analysis was used to estimate freedom from ICD shock, heart transplantation, and death. Cox proportional hazards models were used to analyze variables associated with ICD shock recurrence and mortality after CSD.RESULTS: Between 2009 and 2016, 121 patients (age 55 ± 13 years, 26% female, mean ejection fraction of 30 ± 13%) underwent left or bilateral CSD. One-year freedom from sustained VT/ICD shock and ICD shock, transplant, and death were 58% and 50%, respectively. CSD reduced the burden of ICD shocks from a mean of 18 ± 30 (median 10) in the year before study entry to 2.0 ± 4.3 (median 0) at a median follow-up of 1.1 years (p < 0.01). On multivariable analysis, pre-procedure New York Heart Association functional class III and IV heart failure and longer VT cycle lengths were associated with recurrent ICD shocks, whereas advanced New York Heart Association functional class, longer VT cycle lengths, and a left-sided-only procedure predicted the combined endpoint of sustained VT/ICD shock recurrence, death, and transplantation. Of the 120 patients taking antiarrhythmic medications before CSD, 39 (32%) no longer required them at follow-up.CONCLUSIONS: CSD decreased sustained VT and ICD shock recurrence in patients with refractory VT. Characteristics independently associated with recurrence and mortality were advanced heart failure, VT cycle length, and a left-sided-only procedure.

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KW - antiarrhythmic drugs

KW - autonomic nervous system

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