Anesthetic Considerations for Thoracoscopic Sympathetic Ganglionectomy to Treat Ventricular Tachycardia Storm: A Single-Center Experience

Background: Cardiac sympathetic denervation (CSD) is being used in the management of refractory ventricular tachycardia (VT) and electrical storm. However, data on the role of CSD in the management of ventricular arrhythmia is limited. Methods: We performed a meta-analysis of retrospective studies to calculate the pooled rate of freedom from VT and the standard mean difference of ICD shocks before and after CSD. Results: 14 nonrandomized studies with a total of 311 patients with refractory VT or electrical storm were included. At a mean follow up of 15 ± 10.7 months, the pooled rate of freedom from VT (VT nonrecurrence rate) after CSD in all causes of arrhythmia was 60% (range 48.8% to 70%, I 2 = 43%). When analysis was restricted to only arrhythmias caused by conditions other than catecholaminergic polymorphic ventricular tachycardia (CPVT) and long QT syndrome (LQTS), the pooled VT non-recurrence rate was 50% (range 41% to 58%, I 2 = 5%). After CSD, mean total number of ICD shocks per person diminished by 3.01 (95% CI 1.09-4.94, P = .002, I 2 = 96%) in overall analysis and by 0.97(95% CI 0.41-1.5, P = .001, I 2 = 45%) when CPVT and LQTS were excluded. Conclusion: In patients with refractory VT or electrical storm, CSD is associated with pooled VT nonrecurrence rate of 60% at a mean follow-up of 15 ± 10.7 months. CSD was also associated with significantly lower mean number ICD shocks per person. Further studies are needed to validate this finding in a prospective setting.

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“…We included 14 nonrandomized studies in our final analysis. 5,[11][12][13][14][15][16][17][18][19][20][21][22][23] Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Prisma flow diagram for the study selection is shown in Figure 1. We included 14 nonrandomized studies in our final analysis 5,11‐23 . Majority of the studies were from North America.…”

Section: Resultsmentioning

confidence: 99%

Role of cardiac sympathetic denervation in ventricular tachycardia: A meta‐analysis

Murtaza

Sharma

Akella

et al. 2020

Pacing Clinical Electrophis

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“…Thoracic epidural anaesthesia might reduce the incidence of ventricular arrhythmias by blocking cardiac sympathetic fibres. [ 13 ] Stellate ganglionectomy is another option to treat sympathetically mediated VT.[ 14 ] In patients undergoing thoracic surgeries, thoracic epidural infusion is believed to reduce the episodes of tachycardia. [ 15 ] Whenever there is a need for temporary pacing, the cardiologist may be called for intervention.…”

Section: Treatmentmentioning

confidence: 99%

Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation

Parida

Thangaswamy

2017

Indian J Anaesth

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Cardiac tachyarrhythmias are encountered commonly during the perioperative period and need to be promptly identified and appropriately managed by the anaesthesiologist. This review intends to highlight important aspects of these tachyarrhythmias and explore a temporal relationship between common medications employed in the perioperative period and their causation. Mechanisms of initiation of tachyarrhythmias, drugs that can trigger those, as well as their diagnosis and management, are also parts of the current review. Cardiac tachyarrhythmias may not always require treatment, and sometimes, aggressive management can trigger more serious types of arrhythmias. A thorough understanding of these tachyarrhythmias and their pathogenesis enables adopting a more objective approach, eschewing risks of inappropriate or unnecessary management strategies. We performed a MEDLINE search using combinations of MeSH terms such as ‘cardiac’, ‘arrhythmias’, ‘anaesthesia’, ‘perioperative’, ‘tachyarrhythmias’ and ‘anaesthetic implications’. We reviewed the relevant publications with regard to cardiac tachyarrhythmias occurring in the perioperative period.

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“…long QT syndrome) [81-83]. However, whether such interventions may be used for all ventricular arrhythmias or only a subset is unclear [84-86]. …”

Section: Clinical Correlatesmentioning

confidence: 99%

Innervation of the heart: An invisible grid within a black box

Kapa

DeSimone

Asirvatham

2016

Trends in Cardiovascular Medicine

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Autonomic control of cardiovascular function is mediated by a complex interplay between central, peripheral, and innate cardiac components. This interplay is what mediates the normal cardiovascular response to physiologic and pathologic stressors, including blood pressure, cardiac contractile function, and arrhythmias. However, in order to understand how modern therapies directly affecting autonomic function may be harnessed to treat various cardiovascular disease states requires an intimate understanding of anatomic and physiologic features of the innervation of the heart. Thus, in this review, we focus on defining features of the central, peripheral, and cardiac components of cardiac innervation, how each component may contribute to dysregulation of normal cardiac function in various disease states and how modulation of these components may offer therapeutic options for these diseases.

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Anesthetic Considerations for Thoracoscopic Sympathetic Ganglionectomy to Treat Ventricular Tachycardia Storm: A Single-Center Experience

Cited by 16 publications

References 28 publications

Role of cardiac sympathetic denervation in ventricular tachycardia: A meta‐analysis

Role of cardiac sympathetic denervation in ventricular tachycardia: A meta‐analysis

Cardiac tachyarrhythmias and anaesthesia: General principles and focus on atrial fibrillation

Innervation of the heart: An invisible grid within a black box

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