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Videoscopic left cardiac sympathetic denervation for patients with recurrent ventricular fibrillation/malignant ventricular arrhythmia syndromes besides congenital long-QT syndrome Coleman MA; Bos JM; Johnson JN; Owen HJ; Deschamps C; Moir C; Ackerman MJCirc Arrhythm Electrophysiol 2012[Aug]; 5 (4): 782-8BACKGROUND: Treatment options for patients with recurrent ventricular arrhythmias refractory to pharmacotherapy and ablation are minimal. Although left cardiac sympathetic denervation (LCSD) is well established in long-QT syndrome, its role in non-long-QT syndrome arrhythmogenic channelopathies and cardiomyopathies is less clear. Here, we report our single-center experience in performing LCSD in this setting. METHODS AND RESULTS: In this institutional review board-approved study, we retrospectively reviewed the electronic medical records of all patients (N=91) who had videoscopic LCSD at our institution from 2005 to 2011. Data were analyzed for the subset (n=27) who were denervated for an underlying diagnosis other than autosomal dominant or sporadic long-QT syndrome. The spectrum of arrhythmogenic disease included catecholaminergic polymorphic ventricular tachycardia (n=13), Jervell and Lange-Nielsen syndrome (n=5), idiopathic ventricular fibrillation (n=4), left ventricular noncompaction (n=2), hypertrophic cardiomyopathy (n=1), ischemic cardiomyopathy (n=1), and arrhythmogenic right ventricular cardiomyopathy (n=1). Five patients had LCSD because of high-risk assessment and beta-blocker intolerance, none of whom had a sentinel breakthrough cardiac event at early follow-up. Among the remaining 22 previously symptomatic patients who had LCSD as secondary prevention, all had an attenuation in cardiac events, with 18 having no breakthrough cardiac events so far and 4 having experienced >/=1 post-LCSD breakthrough cardiac event. CONCLUSIONS: LCSD may represent a substrate-independent antifibrillatory treatment option for patients with life-threatening ventricular arrhythmia syndromes other than long-QT syndrome. The early follow-up seems promising, with a marked reduction in the frequency of cardiac events postdenervation.|*Endoscopy/adverse effects[MESH]|*Video-Assisted Surgery/adverse effects[MESH]|Adolescent[MESH]|Adult[MESH]|Arrhythmogenic Right Ventricular Dysplasia/physiopathology/surgery[MESH]|Child[MESH]|Child, Preschool[MESH]|Disease-Free Survival[MESH]|Female[MESH]|Heart/*innervation[MESH]|Humans[MESH]|Infant[MESH]|Isolated Noncompaction of the Ventricular Myocardium/physiopathology/surgery[MESH]|Jervell-Lange Nielsen Syndrome/physiopathology/surgery[MESH]|Kaplan-Meier Estimate[MESH]|Male[MESH]|Middle Aged[MESH]|Minnesota[MESH]|Polymorphic Catecholaminergic Ventricular Tachycardia[MESH]|Recurrence[MESH]|Retrospective Studies[MESH]|Sympathectomy/adverse effects/*methods[MESH]|Sympathetic Nervous System/*physiopathology[MESH]|Tachycardia, Ventricular/diagnosis/physiopathology/*surgery[MESH]|Time Factors[MESH]|Treatment Outcome[MESH]|Ventricular Fibrillation/diagnosis/physiopathology/*surgery[MESH]|Young Adult[MESH] |
