Autonomic Modulation for Treatment of Repolarization Alternans and Refractory Ventricular Electrical Storm
Ajay Pillai1, Jayanthi N Koneru1, Kenneth A Ellenbogen1
1Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, Virginia, USA.
JACC. Case Reports
|September 24, 2021
Summary
Macroscopic T-wave alternans (TWA), a rare ECG finding linked to sudden cardiac death risk, was observed. Autonomic modulation improved TWA and prolonged QTc in a patient experiencing electrical storm.
Area of Science:
- Cardiology
- Electrophysiology
- Autonomic Nervous System
Background:
- Macroscopic T-wave alternans (TWA) on electrocardiogram (ECG) is a rare but significant finding.
- TWA is associated with an elevated risk of sudden cardiac death.
- Prolonged QTc interval is a known risk factor for cardiac arrhythmias.
Observation:
- A case of macroscopic TWA in a patient with a markedly prolonged QTc interval is presented.
- The patient experienced recurrent ventricular electrical storm.
- Medical management for the electrical storm was refractory.
Findings:
- Autonomic modulation targeting the stellate ganglion was performed.
- This intervention led to a notable improvement in both TWA and QTc interval.
- The findings suggest a link between autonomic dysfunction and TWA in this context.
Implications:
- Stellate ganglion modulation may be a potential therapeutic strategy for managing TWA and associated arrhythmias.
- This case highlights the role of the autonomic nervous system in TWA.
- Further research is warranted to explore autonomic modulation for cardiac electrical instability.
Keywords:
ECG, electrocardiogramICD, implantable cardioverter-defibrillatorelectrophysiologytreatmentventricular fibrillationventricular tachycardiaMore Related Videos
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