Prevention of postischemic ventricular fibrillation late after right or left stellate ganglionectomy in dogs.

Abstract

To gain insight into the differences in antiarrhythmic potential of right vs left stellate ganglionectomy, 72 dogs were randomized to either unilateral stellectomy or second intercostal space thoracotomy and left circumflex coronary arteriovenous pedicle occlusion was performed, without vagotomy, a mean of 8 weeks later under anesthesia. The type and timing of ventricular ectopic beats, including both nonsustained and sustained ventricular tachycardia and ventricular fibrillation, were investigated. Several covariates, including postischemic electrocardiographic changes, were considered. Both right and left stellate ganglionectomy reduced the incidence of early (0 to 10 min) (p = .004 and p = .001, respectively) and total (0 to 60 min) (p = .009 and p = .008, respectively) ischemia-induced ventricular fibrillation, and improved outcome (p = .0013 and p = .0012, respectively). Early sustained ventricular tachycardia was similarly reduced (p = .02) in both stellectomized groups. By contrast, neither the type nor the time distribution of the other forms of ventricular arrhythmias differed significantly among the randomized groups. The multivariate Cox's regression model showed that ST segment elevation at 3 min postocclusion, unilateral stellate ganglionectomy (either right or left), sex, and weight were significant independent predictors of the incidence of ventricular fibrillation during the occlusion period. Lower ST segment elevation and reduced incidence of sustained ventricular tachycardia in the early postischemic period might explain improved outcome in stellectomized dogs by Cox analysis. The side of intervention (either stellectomy or sham operation) did not influence survival; however, left-sided interventions were more effective than right-sided ones. These results confirm the previously reported antifibrillatory effect of left and indicate like effects of right stellate ganglionectomy in a randomized experimental study. Circulation 77, No. 4, 935-946, 1988. IT IS generally believed that increased sympathetic tone at the onset of acute myocardial ischemia contributes to life-threatening arrhythmias in a variety of animal preparations, including anesthetized, morphine-sedated, and conscious ones.

Effect of stellate ganglia stimulation on global and regional left ventricular function as assessed by speckle tracking echocardiography

“…In conscious dogs with prior anterior myocardial infarction, left stellectomy seemed to protect against ventricular fibrillation during acute myocardial ischemia (40). In an anesthetized dog model without prior myocardial infarction, either left or right stellectomy protected against death by ventricular fibrillation after coronary occlusion (32). Unilateral increases and decreases of sympathetic tone to the heart can induce an asynchronous wall motion pattern affecting cardiac function (38,39).…”

Diabetes and haemodynamic reactions to acute coronary occlusion

“…Earlier studies have shown that hypotension is a common phenomenon already during the early stages of acute coronary occlusion both in the experimental and clinical settings [18,23,24]. The background of early hypotension involves complex mechanisms.…”

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

“…17 The left cardiac sympathetic system is recognized as predominantly regulating arrhythmogenic potential, whereas the right-sided system primarily regulates heart rate. 18-20 Left sympathectomy is, therefore, usually the initial surgery of choice, although staged or concurrent right-sided sympathectomy also can be performed when the etiology of the ventricular arrhythmia is deemed to be more complex (a synergistic interaction between arrhythmogenic stimulation and heart rate, for example) or particularly sensitive to sympathetic stimulation. This differs from recommendations for ganglionic blockade, for which bilateral blockade absolutely is contraindicated because of concerns for fully eradicating sympathetic tone to the heart.…”