Management of ventricular storm with thoracic epidural anesthesia

Basantwani, Shakuntala; Shinde, Shital Rajesh; Tendolkar, Bharati A

doi:10.4103/aca.aca_98_18

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…Thoracic epidural anesthesia (TEA) has also emerged as a promising and relatively noninvasive neuromodulatory approach that was reported to decrease ventricular arrhythmia burden in small case series of patients with structural heart disease and in animal models of myocardial infarction [ 296 – 298 ]. Administration of an anesthetic agent in the epidural space can block both spinal afferent and sympathetic efferent signals in a reversible fashion.…”

Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

“…Administration of an anesthetic agent in the epidural space can block both spinal afferent and sympathetic efferent signals in a reversible fashion. TEA can acutely stabilize patients with recurrent VA, allowing these patients to be bridged to more permanent therapies such as CSD, catheter ablation, or cardiac transplantation [ 296 , 297 , 299 ]. Its broader applicability has been limited by the need for interruption of blood thinners and its potentially unknown effects on hemodynamic parameters, as cardiac sympathetic outflow becomes significantly decreased.…”

Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

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Autonomic control of ventricular function in health and disease: current state of the art

2023

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Purpose Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. Methods Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. Results A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. Conclusions Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.

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Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

Autonomic control of ventricular function in health and disease: current state of the art

2023

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“…Clinical improvement and noting Horner's syndrome on clinical examination could be surrogates for the effectiveness. [14][15][16][17]18 Surgical cardiac sympathetic denervation has been shown to reduce short and long-term recurrence of arrhythmia and could be undertaken ahead of catheter ablation therapies. 7,19 Finally, catheter ablation techniques would map the offending areas before ablation and find appropriate ICD and pacemakers for arrhythmia control in case of a late breakthrough.…”

Section: Introductionmentioning

confidence: 99%

Neuraxial Modulation in Electrical Storm: A Case Report

Gopaldas,

Padmanabhan,

Narayanaswamy

et al. 2024

Journal of Acute Care

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Aims and background: Management of unstable and refractory electrical storm (ES) requires a multidisciplinary approach in an intensive care unit (ICU). A dysregulated autonomic system is understood to be the cause of perpetual arrhythmogenesis. Case description: We present a case of refractory ES precipitated by myocardial ischemia (MI), which was promptly managed with primary percutaneous coronary intervention (PPCI). Despite successful reperfusion with PPCI, the patient continued to have arrhythmias for a prolonged period than expected. Due to refractory arrhythmia, escalation of antiarrhythmic drugs (AADs) along with sequential sympatholytic therapy was undertaken. Conclusion:The use of neuraxial modulation [initially stellate ganglion block (SGB) followed by surgical sympathectomy] may lead to the control of arrhythmia and hemodynamic stability in this difficult subset of patients. Clinical significance: Unstable ES is due to inappropriate sympathetic system activation and there is mounting evidence in support of neuraxial modulation as the main modality rather than escalating traditional AADs.

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“…[ 2 ] Patients with refractory arrhythmias or presenting with electrical storms, who are not responsive to pharmacological treatment with beta blockers, thoracic epidural anesthesia, ablation, and ICD therapy, are considered candidates for VATS procedure. [ 3 4 ]…”

Section: Introductionmentioning

confidence: 99%

Anesthetic management in bilateral video-assisted thoracoscopic sympathectomy for refractory ventricular arrhythmias: A case report

et al. 2021

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Cardiac Sympathetic Denervation (CSD) has been shown to reduce shocks and subsequent pain of implantable cardiac defibrillator (ICD) in patients with heart diseases and recurrent Ventricular Tachycardia (VT) who did not respond properly to oral therapy and ablation. A 68-year-old man who presented an idiopathic dilated cardiomyopathy with impaired ejection fraction was treated for VT. A bilateral cardiac sympathetic denervation was performed under general anesthesia. Patient was extubated in the operating room and transferred to ICU where he presented hypotension. He was discharged after five days and remained symptom-free without any incident of VT during hospital stay. Currently no definite anesthetic management is available to treat such patients. This report discusses an approach that made heart rate control and safe patient discharge possible.

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Management of ventricular storm with thoracic epidural anesthesia

Cited by 8 publications

References 11 publications

Autonomic control of ventricular function in health and disease: current state of the art

Autonomic control of ventricular function in health and disease: current state of the art

Neuraxial Modulation in Electrical Storm: A Case Report

Anesthetic management in bilateral video-assisted thoracoscopic sympathectomy for refractory ventricular arrhythmias: A case report

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