Effects of stepwise denervation of the stellate ganglion: Novel insights from an acute canine study

Wu, Gang; DeSimone, Christopher V.; Suddendorf, Scott H.; Asirvatham, Roshini; Asirvatham, Samuel J.; Huang, Congxin; Chen, Peng Sheng; Mei, Yong

doi:10.1016/j.hrthm.2016.03.010

Cited by 10 publications

(7 citation statements)

References 33 publications

(21 reference statements)

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“…This finding suggests that the sympathetic block is not strongly associated with manipulation of the atrioventricular node, His‐Purkinje conduction, myocardial depolarization, and repolarization. This finding is in keeping with the observation in our animal study . In that study, QRS intervals were not significantly changed during SG stimulation or after SG removal, despite the fact that HR was significantly regulated by the same maneuver.…”

Section: Discussionsupporting

confidence: 92%

“…Studies have shown that sympathetic stimulation and block affect the sinus rate significantly . In a case report, renal sympathetic denervation reduced HR in a patient with drug‐refractory IST …”

Section: Discussionmentioning

confidence: 95%

“…4,24,25 In a case report, renal sympathetic denervation reduced HR in a patient with drug-refractory IST. 26 In view of the beneficial effects of sympatholysis for treating various conditions related to sympathetic hyperactivity and lack of effective medical therapy for IST, we proposed a clinical practice protocol and collected the data carefully. Our study clearly showed in the procedure room, an acute temporal effect of SG block on sinus rate reduction within 20 minutes after right SG block by 16 bpm, although the modest HR change after left SG block did not reach statistical significance.…”

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confidence: 99%

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Stellate ganglion block and cardiac sympathetic denervation in patients with inappropriate sinus tachycardia

Mei

Yang

et al. 2019

Cardiovasc electrophysiol

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Background Inappropriate sinus tachycardia (IST) remains a clinical challenge because patients often are highly symptomatic and not responsive to medical therapy. Objective To study the safety and efficacy of stellate ganglion (SG) block and cardiac sympathetic denervation (CSD) in patients with IST. Methods Twelve consecutive patients who had drug‐refractory IST (10 women) were studied. According to a prospectively initiated protocol, five patients underwent an electrophysiologic study before and after SG block (electrophysiology study group). The subsequent seven patients had ambulatory Holter monitoring before and after SG block (ambulatory group). All patients underwent SG block on the right side first, and then on the left side. Selected patients who had heart rate reduction ≥15 beats per minute (bpm) were recommended to consider CSD. Results The mean (SD) baseline heart rate (HR) was 106 (21) bpm. The HR significantly decreased to 93 (20) bpm (P = .02) at 10 minutes after right SG block and remained significantly slower at 97(19) bpm at 60 minutes. Left SG block reduced HR from 99 (21) to 87(16) bpm (P = .02) at 60 minutes. SG block had no significant effect on blood pressure or HR response to isoproterenol or exercise (all P > .05). Five patients underwent right (n = 4) or bilateral (n = 1) CSD. The clinical outcomes were heterogeneous: one patient had complete and two had partial symptomatic relief, and two did not have improvement. Conclusion SG blockade modestly reduces resting HR but has no significant effect on HR during exercise. Permanent CSD may have a modest role in alleviating symptoms in selected patients with IST.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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Stellate ganglion block and cardiac sympathetic denervation in patients with inappropriate sinus tachycardia

Mei

Yang

et al. 2019

Cardiovasc electrophysiol

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“…Our previous study showed that stimulation of the left or right stellate ganglion had no effects on ventricular ERP and other electrophysiologic parameters in a dog model . The results of the present study concurred with the findings in that animal study.…”

Section: Discussionsupporting

confidence: 92%

Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease

Cai

Dai

Tian

et al. 2019

Cardiovasc electrophysiol

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Introduction Autonomic modulation has been used as a therapy to control recurrent ventricular arrhythmia (VA). This study was to explore stellate ganglion block (SGB) effect on cardiac electrophysiologic properties and evaluate the long‐term outcome of cardiac sympathetic denervation (CSD) for patients with recurrent VA and structural heart disease (SHD). Materials and Methods Patients who had recurrent VA due to SHD were enrolled prospectively. Electrophysiologic study and ventricular tachycardia (VT) induction were performed before and after left and right SGB. VA burden and long‐term outcomes were assessed for a separate patient group who underwent left or bilateral CSD for drug‐refractory VA due to SHD. Results Electrophysiologic study of nine patients showed that baseline mean (SD) corrected sinus node recovery time (cSNRT) increased from 320.4 (73.3) ms to 402.9 (114.2) ms after left and 482.4 (95.7) ms after bilateral SGB (P = .03). SGB did not significantly change P‐R, QRS, and Q‐T intervals and ventricular effective refractory period, nor did the inducibility of VA. Nineteen patients underwent left (n = 14) or bilateral (n = 5) CSD. CSD reduced VA burden and appropriate ICD therapies from a median (interquartile range) of 2.5 (0.4‐11.6) episodes weekly to 0.1 (0.0‐2.4) episodes weekly at 6‐month follow‐up (P = .002). Three‐year freedom from orthotopic heart transplant (OHT) and death was 52.6%. New York Heart Association functional class III/IV and VT rate less than 160 beats per minute were predictors of recurrent VA, OHT, and death. Conclusion SGB increased cSNRT without changing heart rate. CSD was more beneficial for patients with mild‐to‐moderate heart failure and faster VA.

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“…42 Autonomic modulation is being actively studied as a modality for the treatment of atrial arrhythmias, hypertension, and episodic hypotension. 43,44 Autonomic modulation could be effective in ameliorating IST in the future, without direct ablation performed in the sinus node region.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Sinus Tachycardia: Current Challenges and Future Directions

Yasin¹,

Vaidya²,

Chacko³

et al. 2018

J Innov Cardiac Rhythm Manage.

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Effects of stepwise denervation of the stellate ganglion: Novel insights from an acute canine study

Cited by 10 publications

References 33 publications

Stellate ganglion block and cardiac sympathetic denervation in patients with inappropriate sinus tachycardia

Stellate ganglion block and cardiac sympathetic denervation in patients with inappropriate sinus tachycardia

Electrophysiologic effects and outcomes of sympatholysis in patients with recurrent ventricular arrhythmia and structural heart disease

Inappropriate Sinus Tachycardia: Current Challenges and Future Directions

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