1. Prognostic impact of atrial rhythm and dimension in patients with structural heart disease undergoing cardiac sympathetic denervation for ventricular arrhythmias.
- Author
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Dusi, Veronica, Sorg, Julie M, Gornbein, Jeffrey, Gima, Jean, Yanagawa, Jane, Lee, Jay M, Vecerek, Natalia, Vaseghi, Marmar, Bradfield, Jason S, De Ferrari, Gaetano M, Shivkumar, Kalyanam, and Ajijola, Olujimi A
- Subjects
Heart Atria ,Heart Conduction System ,Humans ,Tachycardia ,Ventricular ,Echocardiography ,Stroke Volume ,Prognosis ,Treatment Outcome ,Sympathectomy ,Retrospective Studies ,Follow-Up Studies ,Heart Rate ,Atrial Function ,Middle Aged ,Female ,Male ,Atrial arrhythmias ,Autonomic nervous system ,Cardiac sympathetic denervation ,Left atrial volume index ,Structural heart disease ,Clinical Research ,Cardiovascular ,Heart Disease ,Biomedical Engineering ,Cardiorespiratory Medicine and Haematology ,Cardiovascular System & Hematology - Abstract
BackgroundCardiac sympathetic denervation (CSD) is a promising treatment for patients with structural heart disease (SHD) and refractory ventricular tachyarrhythmias (VTs). The effect of CSD on atrial rhythm as well as the prognostic impact of atrial arrhythmias (AAs) or left atrial volume index (LAVI) on CSD outcome are unknown.ObjectivesThe goals of this study were to evaluate the impact of AAs and LAVI on CSD outcome and to assess changes in AAs burden and in atrial pacing after CSD.MethodsPatients with SHD undergoing CSD for VTs were analyzed. Hazards models were built to assess predictors of sustained VT/implantable cardioverter-defibrillator (ICD) shock recurrences and death/orthotopic heart transplant (OHT). Changes before vs after CSD were assessed using ICD, clinical, and echocardiographic data. A drug index was devised to correct for medication use.ResultsBetween 2009 and 2018, 91 patients (mean age 56 ± 13 years; mean left ventricular ejection fraction 34% ± 14%; 47% with a history of AAs) underwent left CSD (16%) or bilateral CSD (BCSD). The median follow-up was 14 months (interquartile range 4-37 months). Using multivariable analysis, neither LAVI nor AAs were associated with recurrences; LAVI was an independent predictor of death/OHT. AAs burden did not change after BCSD, but atrial pacing increased from a median of 28% to 72% (P < .01). Left ventricular end-diastolic diameter slightly increased; however, sustained VT/ICD shocks were reduced.ConclusionIn patients with SHD undergoing CSD, LAVI predicts death/OHT. AAs burden, already low at baseline, was unchanged after BCSD, while the need for atrial pacing increased, suggesting an impact of BCSD on sinus node chronotropism.
- Published
- 2020