背景:神经调节越来越被认为是难治性室性心律失常(VA)患者的治疗策略。经皮星状神经节阻滞(SGB),经皮磁刺激(TcMS),和手术心脏交感神经支配术(CSD)均已在此设置中使用。
目的:本研究旨在描述这些神经调节技术在难治性VA患者中的当代应用和结果。
方法:这项回顾性队列研究包括2019年至2021年在宾夕法尼亚大学医院接受抗心律失常药物(AAD)难治性VA治疗的所有患者,TcMS,或CSD。
结果:共34例患者(年龄61±14岁,15个多态VAs[44%],对1.8±0.8AAD的难治性)符合纳入标准。对11例患者(32%)进行了SGB,TcMS在19(56%),和CSD在7(21%)。神经调节与持续VAs发作次数减少相关,从初始神经调节策略前24小时的7[IQR:4-12]发作减少到随后24小时的0[IQR:0-1]发作(P<0.001)。在1.2±1.1年的随访期间,21人(62%)经历了复发性VAs,在这些病人中,中位复发时间为3[IQR:1-25]天.单态和多态VAs患者的预后相似。在神经调节前30天内发生急性心肌梗死的患者中,在治疗后24小时内,VA的负担从11[IQR:7-12]发作减少到0发作。
结论:用SGB进行自主神经调节,TcMS,在AAD-难治性VAs患者中或CSD是安全的,虽然复发性心律失常是常见的,但导致VA显著急性减少,并不是所有患者的心律失常负担都有所减轻。
Neuromodulation is increasingly recognized as a therapeutic strategy for patients with refractory ventricular arrhythmias (VAs). Percutaneous stellate ganglion blockade (SGB), transcutaneous magnetic stimulation (TcMS), and surgical cardiac sympathetic denervation (CSD) have all been utilized in this setting.
This study sought to characterize contemporary use and outcomes of these neuromodulation techniques for patients with refractory VA.
This retrospective cohort study included all patients at the Hospital of the University of Pennsylvania with antiarrhythmic drug (AAD)-refractory VA from 2019 to 2021 who were treated with SGB, TcMS, or CSD.
A total of 34 patients (age 61 ± 14 years, 15 polymorphic VAs [44%], refractory to 1.8 ± 0.8 AADs) met inclusion criteria. SGB was performed on 11 patients (32%), TcMS on 19 (56%), and CSD on 7 (21%). Neuromodulation was associated with a reduction in the number of episodes of sustained VAs from 7 [IQR: 4-12] episodes in the 24 hours before the initial neuromodulation strategy to 0 [IQR: 0-1] episodes in the subsequent 24 hours (P < 0.001). During 1.2 ± 1.1 years of follow-up, 21 (62%) experienced recurrent VAs, and among those patients, the median time to recurrence was 3 [IQR: 1-25] days. Outcomes were similar among patients with monomorphic and polymorphic VAs. Among patients who had an acute myocardial infarction within 30 days before neuromodulation, the burden of VAs decreased from 11 [IQR: 7-12] episodes to 0 episodes in the 24 hours after treatment.
Autonomic neuromodulation with SGB, TcMS, or CSD in patients with AAD-refractory VAs is safe and results in substantial acute reduction of VA although recurrent arrhythmias are common, and not all patients experience a reduction in arrhythmia burden.