Neuraxial Modulation for Refractory Ventricular Arrhythmias

• DOI: 10.1161/circulationaha.109.929703
• Publication Date: 2010-05-18T03:34:57Z
• Authors: Tara Bourke; Marmar Vaseghi; Yoav Michowitz; Vineet Sankhla; Mandar Shah; Nalla Swapna; Noel G. Boyle; Aman Mahajan; Calambur Narasimhan; Yash Lokhandwala; Kalyanam Shivkumar
• Keywords: Refractory (planetary science)

Background— Reducing sympathetic output to the heart from neuraxis can protect against ventricular arrhythmias. The purpose of this study was assess value thoracic epidural anesthesia (TEA) and left cardiac denervation (LCSD) in management arrhythmias patients with structural disease. Methods Results— Clinical data 14 (25 75 years old, mean±SD 54.2±16.6 years; 13 men) who underwent TEA, LCSD, or both control tachycardia (VT) refractory medical therapy catheter ablation were reviewed. Twelve VT storm, 2 experienced recurrent despite maximal procedures. total number therapies per patient before either procedure ranged 5 202 (median 24; 25th 75th percentile, 56). Eight 9 LCSD (3 had procedures). No major procedural complications occurred. After initiation 6 a large (≥80%) decrease burden. 3 no further VT, that resolved within 24 hours responded ablation, 4 continued have VT. Nine survived hospital discharge (2 TEA alone, TEA/LCSD combined, alone), 1 alone an urgent transplantation. Conclusions— Initiation associated subsequent arrhythmia burden (75%) 8 (68% confidence interval 51% 91%) (56%) 34% 75%), respectively. These suggest may be effective additions disease when other treatment modalities failed serve as bridge more definitive therapy.