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Cardiovascular autonomic reflex function after bilateral cardiac sympathetic denervation for ventricular arrhythmias
- Source :
- Heart rhythm, vol 17, iss 8
- Publication Year :
- 2020
- Publisher :
- eScholarship, University of California, 2020.
-
Abstract
- BackgroundBilateral cardiac sympathetic denervation (BCSD) is an effective therapy for ventricular arrhythmias (VAs) in cardiomyopathies (CMPs). After BCSD, residual autonomic nervous system (ANS) function is unknown.ObjectiveThe purpose of this study was to assess ANS responses in patients with CMP before and after BCSD as compared with demographically matched healthy controls.MethodsPatients with CMP undergoing BCSD and matched healthy controls were recruited. Noninvasive measures-finger cuff beat-to-beat blood pressure (BP), electrocardiography, palmar electrodermal activity (EDA), and finger pulse volume (FPV)-were obtained at rest and during autonomic stressors-posture change, handgrip, and mental stress. Maximal as well as specific responses to stressors were compared.ResultsEighteen patients with CMP (mean age 54 ± 14 years; 16 men, 89%; left ventricular ejection fraction 36% ± 14%) with refractory VAs and 8 matched healthy controls were studied; 9 patients with CMP underwent testing before and after (median 28 days) BCSD, with comparable ongoing medication. Before BCSD, patients with CMP (n = 13) had lower resting systolic BP and FPV than did healthy controls (P < .01). Maximal FPV and systolic BP reflex responses, expressed as percent change were similar, while diastolic BP, mean BP, and EDA responses were blunted. After BCSD, resting measurements were unchanged relative to presurgical baseline (n = 9). EDA responses to stressors were abolished, confirming BCSD, while maximal FPV and BP responses were preserved. Diastolic BP, mean BP, and FPV responses to orthostatic challenge pointed toward a better tolerance of active standing after BCSD as compared with before. Responses to other stressors remained unchanged.ConclusionPatients with CMP and refractory VAs on optimal medical therapy have detectable but blunted adrenergic responses, which are not disrupted by BCSD.
- Subjects :
- Male
Cardiac sympathetic denervation
Biomedical Engineering
Blood Pressure
Cardiorespiratory Medicine and Haematology
Autonomic Nervous System
Cardiovascular
Electrocardiography
Ventricular arrhythmias
Heart Rate
Clinical Research
Tachycardia
Reflex
Humans
Sympathectomy
Autonomic reflexes
Retrospective Studies
Ventricular
Neurosciences
Adrenergic responses
Middle Aged
Treatment Outcome
Heart Disease
Cardiovascular System & Hematology
Hypertension
Female
Cardiomyopathies
Follow-Up Studies
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Heart rhythm, vol 17, iss 8
- Accession number :
- edsair.od.......325..a72982cf2c27d795a56e4ab04b6263f0