Spontaneous stellate ganglion nerve activity and ventricular arrhythmia in a canine model of sudden death

Zhou, Shengmei; Jung, Byung Chun; Tan, Alex Y.; Trang, Vinh Quang; Gholmieh, Ghassan; Han, Seungyeup; Lin, Shien Fong; Fishbein, Michael C.; Chen, Peng Sheng; Chen, Lan S.

doi:10.1016/j.hrthm.2007.09.007

Cited by 175 publications

(145 citation statements)

References 23 publications

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“…2 Later, Cao's group and others described similar cardiac sympathetic hyperinnervation in both adults and animals, including a history of ventricular arrhythmias and sudden cardiac death. [3][4][5] The patient described in this report suffered from both cardiac ischemia and obstructive sleep apnea, both of which lead to enhanced sympathetic output, nerve sprouting, and arrhythmogenic regional heterogeneities of sympathetic innervation. [6][7][8][9] The increased sympathetic activation resulting from this patient's medical history likely played a significant role in the development and refractory nature of the ventricular tachyarrhythmia.…”

Section: Discussionmentioning

confidence: 92%

Bilateral thoracic sympathetic block for refractory polymorphic tachycardia

Allen

Weaver

Burkey

2011

Can J Anesth/J Can Anesth

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Introduction Extensive evidence has established a link between sympathetic nervous system hyperactivity, ventricular arrhythmias, and sudden cardiac death. For this reason, cardiac sympathectomy is often beneficial in the treatment of patients at high risk for ventricular ectopy, although it involves an invasive procedure associated with potential morbidity. We report a case in which we used guided lytic thoracic sympathetic block in a patient with underlying cardiomyopathy and refractory polymorphic ventricular tachycardia. Clinical features A 74-yr-old African American male with ischemic cardiomyopathy presented with refractory episodes of ventricular tachycardia despite maximal medical therapy involving antiarrhythmic drugs and previous interventions, including endovascular epicardial ablation and open cryoablation via sternotomy. During his inpatient admission, the patient developed sustained ventricular tachycardia associated with cardiac depression requiring vasopressors. An open thoracoscopic sympathectomy was considered as a possible treatment, but in our view, the patient would not tolerate this procedure. As an alternative, the pain medicine team successfully performed a lytic thoracic sympathetic block. Subsequently, the patient demonstrated a period of clinical improvement with no apparent morbidity related to the procedure. Conclusion Lytic thoracic sympathetic blockade is a novel technique for the treatment of sympathetically mediated ventricular tachycardia, and it is less invasive than other types of cardiac sympathectomy. Additional studies are required to evaluate this treatment as a viable alternative in patients at high risk for ventricular ectopy. This report suggests the feasibility of this approach and the potential for minimal morbidity in cases of refractory ventricular arrhythmias. RésuméIntroduction De nombreuses donne´es probantes ont e´tabli qu'il existait un lien entre l'hyperactivite´du syste`me nerveux sympathique, les arythmies ventriculaires et la mort cardiaque subite. Pour cette raison, la sympathectomie cardiaque est souvent be´ne´fique pour traiter les patients pre´sentant un risque e´leve´d'ectopie ventriculaire, en de´pit du fait qu'il s'agisse d'une intervention effractive qui peut entraıˆner une morbidite´. Nous rapportons un cas dans lequel nous avons re´alise´un bloc sympathique thoracique lytique guide´chez un patient atteint d'une cardiomyopathie sous-jacente ainsi que d'une tachycardie ventriculaire polymorphe re´fractaire. É léments cliniques Un homme de 74 ans d'origine afro-ame´ricaine souffrant de cardiomyopathie ische´mique a manifeste´des e´pisodes re´fractaires de tachycardie ventriculaire malgre´un traitement me´dical maximal comportant des me´dicaments anti-arythmiques et des interventions par le passe´, notamment une ablation e´picardique endovasculaire et une cryoablation par voie ouverte via sternotomie. Pendant son hospitalisation, le patient a manifeste´une tachycardie ventriculaire soutenue associe´e à une de´pression cardiaque et ne´cessitant...

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Section: Discussionmentioning

confidence: 92%

Bilateral thoracic sympathetic block for refractory polymorphic tachycardia

Allen

Weaver

Burkey

2011

Can J Anesth/J Can Anesth

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“…These findings suggest that high-amplitude spiky discharges is highly arrhythmogenic in diseased hearts. However, because high-amplitude spiky discharges is also present in normal hearts, the presence of these types of discharge by itself is not pathological (Zhou S, et al, 2008). Fig.…”

Section: Relationship Between Sympathetic Neural Remodeling and Ventrmentioning

confidence: 96%

“…Afterdischarges were present in left stellate ganglion recordings after electrical stimulation. BP = blood pressure; SGNA = stellate ganglion nerve activity (Zhou S, et al, 2008).…”

Section: Relationship Between Sympathetic Neural Remodeling and Ventrmentioning

confidence: 99%

Mechanisms of Postinfarction Electrophysiological Abnormality: Sympathetic Neural Remodeling, Electrical Remodeling and Gap Junction Remodeling

Zhong¹,

Li²,

Ke³

et al. 2012

Advances in Electrocardiograms - Clinical Applications

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“…A direct link between sympathetic activity and ventricular arrhythmia was demonstrated in a canine model of SCD where ventricular arrhythmia was preceded by instantaneous sympathetic activity from ambulatory left stellate ganglion recording (Zhou et al 2008).…”

Section: The Sympathetic Nervous System and Ventricular Arrhythmiasmentioning

confidence: 97%

Neuro-cardiac interaction in malignant ventricular arrhythmia and sudden cardiac death

2016

Autonomic Neuroscience

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Sudden cardiac death as a result of lethal ventricular arrhythmias is a major cause of death in cardiac diseases such as heart failure and prior myocardial infarct. Activity of the autonomic nervous system is often abnormal where sympathetic activity is upregulated and vagal activity reduced in these conditions. The abnormal autonomic state has been shown to be a strong prognostic marker of increased mortality and propensity to lethal arrhythmias, for which there is no effective prevention. Research effort over the years has established good evidence for a causal link between autonomic disturbance and ventricular arrhythmias. However, the detailed electrophysiological mechanisms by which ventricular fibrillation occurs are still not clear and molecular processes which are modulated by autonomic nerve influences that either predispose the heart to or protect it from these arrhythmias are not fully understood. This review presents data from studies investigating the link between activity of the autonomic nervous system and ventricular arrhythmias, from seminal findings in classical studies to ongoing investigations, in the quest for a better understanding of the arrhythmogenic mechanisms underlying neurocardiac interactions with a view to the development of effective preventative and therapeutic strategies which are very much needed.

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Spontaneous stellate ganglion nerve activity and ventricular arrhythmia in a canine model of sudden death

Cited by 175 publications

References 23 publications

Bilateral thoracic sympathetic block for refractory polymorphic tachycardia

Bilateral thoracic sympathetic block for refractory polymorphic tachycardia

Mechanisms of Postinfarction Electrophysiological Abnormality: Sympathetic Neural Remodeling, Electrical Remodeling and Gap Junction Remodeling

Neuro-cardiac interaction in malignant ventricular arrhythmia and sudden cardiac death

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