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Published on: December 11, 2017
Long-Term Heart Failure Stabilization and Autonomic Trends After Bilateral Cardiac Sympathetic Denervation
Yuko Miki1, Shingo Yoshimura1, Takehito Sasaki1
1Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Insights
Bilateral cardiac sympathetic denervation (CSD) offers a temporary benefit for heart failure (HF) and ventricular tachycardia (VT) by improving left ventricular (LV) remodeling. However, its effects may wane over time, as indicated by device diagnostics.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Medical Device Technology
Background:
- Bilateral cardiac sympathetic denervation (CSD) is a treatment for refractory ventricular tachycardia (VT).
- The impact of CSD on heart failure (HF) progression and left ventricular (LV) remodeling remains incompletely understood.
- Investigating CSD's long-term effects is crucial for managing complex cardiac conditions.
Background:
Bilateral cardiac sympathetic denervation (CSD) is used for refractory ventricular tachycardia (VT); however, its effects on heart failure (HF) progression and left ventricular (LV) remodeling are unclear.
Case Summary:
A 64-year-old man with ischemic cardiomyopathy was admitted for refractory monomorphic VT after 4 HF-related hospitalizations in the preceding year. Bilateral CSD for refractory VT eliminated HF-related hospitalizations for 32 months and was associated with LV reverse remodeling, with improved ejection fraction (20% → 30%) and reduced LV end-systolic volume index (66 → 50 mL/m2). 123I-metaiodobenzylguanidine scintigraphy demonstrated a reduced myocardial washout rate (62% → 52%). Beginning 28 months post procedure, implantable cardioverter-defibrillator diagnostics revealed a declining atrial pacing burden, suggesting attenuation of the sympatholytic effect and a preceding late VT storm with rapid HF deterioration.
Discussion:
CSD exerted a time-limited stabilizing effect on HF and VT.
Take-Home Message:
CSD may suppress HF progression and promote LV reverse remodeling. Implantable cardioverter-defibrillator-derived autonomic trends may indicate waning benefit.
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