Tags

Type your tag names separated by a space and hit enter

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes.
J Cardiovasc Electrophysiol. 2020 Jun 17 [Online ahead of print]JC

Abstract

INTRODUCTION

Cardiac sympathetic denervation (CSD) is utilized for the management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA.

METHODS

We studied consecutive patients who underwent CSD at our institution from 2009 to 2018 with VT requiring repeat RFA post-CSD. Patient demographics, VT/procedural characteristics, and outcomes were assessed.

RESULTS

Ninety-six patients had CSD, 16 patients underwent RFA for VT post-CSD. There were 15 male and 1 female patients with mean age of 54.2 ± 13.2 years. Fourteen patients had nonischemic cardiomyopathy. A mean of 2.0 ± 0.8 RFAs for VT was unsuccessful before the patient undergoing CSD. The median time between CSD and RFA was 104 days (interquartile range [IQR] = 15-241). The clinical VT cycle length was significantly increased after CSD both spontaneously on ECG and/or ICD interrogation (355 ± 73 ms pre-CSD vs. 422 ± 94 ms post-CSD, p = .001) and intraprocedurally (406 ± 86 ms pre-CSD vs. 457 ± 88 ms post-CSD, p = .03). Two patients had polymorphic and 14 had monomorphic VT (MMVT) pre-CSD, and all patients had MMVT post-CSD. The proportion of mappable, hemodynamically stable VTs increased from 35% during pre-CSD RFA to 58% during post-CSD RFA (p = .038). At median follow-up of 413 days (IQR = 43-1840) after RFA, eight patients had no further VT.

CONCLUSION

RFA for recurrent MMVT post-CSD is a reasonable treatment option with intermediate-term clinical success in 50% of patients. Clinical VT cycle length was significantly increased after CSD with associated improvement in mappable, hemodynamically tolerated VT during RFA.

Authors+Show Affiliations

UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32558054

Citation

Hayase, Justin, et al. "Recurrent Ventricular Tachycardia After Cardiac Sympathetic Denervation: Prolonged Cycle Length With Improved Hemodynamic Tolerance and Ablation Outcomes." Journal of Cardiovascular Electrophysiology, 2020.
Hayase J, Dusi V, Do D, et al. Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes. J Cardiovasc Electrophysiol. 2020.
Hayase, J., Dusi, V., Do, D., Ajijola, O. A., Vaseghi, M., Lee, J. M., Yanagawa, J., Hoftman, N., Revels, S., Buch, E. F., Khakpour, H., Fujimura, O., Krokhaleva, Y., Macias, C., Sorg, J., Gima, J., Pavez, G., Boyle, N. G., Shivkumar, K., & Bradfield, J. S. (2020). Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes. Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.14624
Hayase J, et al. Recurrent Ventricular Tachycardia After Cardiac Sympathetic Denervation: Prolonged Cycle Length With Improved Hemodynamic Tolerance and Ablation Outcomes. J Cardiovasc Electrophysiol. 2020 Jun 17; PubMed PMID: 32558054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes. AU - Hayase,Justin, AU - Dusi,Veronica, AU - Do,Duc, AU - Ajijola,Olujimi A, AU - Vaseghi,Marmar, AU - Lee,Jay M, AU - Yanagawa,Jane, AU - Hoftman,Nir, AU - Revels,Sha'Shonda, AU - Buch,Eric F, AU - Khakpour,Houman, AU - Fujimura,Osamu, AU - Krokhaleva,Yuliya, AU - Macias,Carlos, AU - Sorg,Julie, AU - Gima,Jean, AU - Pavez,Geraldine, AU - Boyle,Noel G, AU - Shivkumar,Kalyanam, AU - Bradfield,Jason S, Y1 - 2020/06/17/ PY - 2020/04/20/received PY - 2020/05/25/revised PY - 2020/06/14/accepted PY - 2020/6/20/pubmed PY - 2020/6/20/medline PY - 2020/6/20/entrez KW - autonomic nervous system KW - cardiac sympathetic denervation KW - catheter ablation KW - stellate ganglion KW - ventricular tachycardia JF - Journal of cardiovascular electrophysiology JO - J. Cardiovasc. Electrophysiol. N2 - INTRODUCTION: Cardiac sympathetic denervation (CSD) is utilized for the management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA. METHODS: We studied consecutive patients who underwent CSD at our institution from 2009 to 2018 with VT requiring repeat RFA post-CSD. Patient demographics, VT/procedural characteristics, and outcomes were assessed. RESULTS: Ninety-six patients had CSD, 16 patients underwent RFA for VT post-CSD. There were 15 male and 1 female patients with mean age of 54.2 ± 13.2 years. Fourteen patients had nonischemic cardiomyopathy. A mean of 2.0 ± 0.8 RFAs for VT was unsuccessful before the patient undergoing CSD. The median time between CSD and RFA was 104 days (interquartile range [IQR] = 15-241). The clinical VT cycle length was significantly increased after CSD both spontaneously on ECG and/or ICD interrogation (355 ± 73 ms pre-CSD vs. 422 ± 94 ms post-CSD, p = .001) and intraprocedurally (406 ± 86 ms pre-CSD vs. 457 ± 88 ms post-CSD, p = .03). Two patients had polymorphic and 14 had monomorphic VT (MMVT) pre-CSD, and all patients had MMVT post-CSD. The proportion of mappable, hemodynamically stable VTs increased from 35% during pre-CSD RFA to 58% during post-CSD RFA (p = .038). At median follow-up of 413 days (IQR = 43-1840) after RFA, eight patients had no further VT. CONCLUSION: RFA for recurrent MMVT post-CSD is a reasonable treatment option with intermediate-term clinical success in 50% of patients. Clinical VT cycle length was significantly increased after CSD with associated improvement in mappable, hemodynamically tolerated VT during RFA. SN - 1540-8167 UR - https://www.unboundmedicine.com/medline/citation/32558054/Recurrent_ventricular_tachycardia_after_cardiac_sympathetic_denervation:_Prolonged_cycle_length_with_improved_hemodynamic_tolerance_and_ablation_outcomes L2 - https://doi.org/10.1111/jce.14624 DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.