Ventricular tachycardia surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]
Overview
Revascularization Procedures in Patients With Ischemic Heart Disease
- Myocardial ischemia is a substrate for sustained polymorphic VT, or VF.
- Revascularization is a treatment of choice for myocardial ischemia.
- Survival after CABG in patients with life-threatening ventricular arrhythmia was reasonable.[1]
- For patients with ischemic heart disease and reduced LVEF undergoing CABG, the risk of sudden cardiac death lessened compared with medical therapy.[2]
- Among survival of SCD, the risk of death reduced by revascularization procedure including PCI or CABG.[3]
- Ischemic heart disease is responsible for 24% to 55% of SCD cases in young patients <35 years of age.
- Anomalous aortic origin of the coronary arteries detected in 10% to 17% of patients in postmortem studies, is an important cause of SCD in the young.[4]
- Revascularization is recommended for treating ischemia leading life-threatening ventricular arrhythmia due to anomalous aortic origin of the coronary arteries.
Surgery for arrhythmia management
- Cardiac surgery is rarely performed for treating ventricular tachycardia in case of highly symptomatic patients with failed antiarrhythmic medications or unsuccessful ventricular ablation.
- Inaccessible sites for ventricular ablation including area deep in the myocardium, beneath epicardial fat, or near the coronary arteries may lead to unsuccessful ablation.
- Surgical ablation of ventricular arrhythmia can be done during other surgical intervention such as placement of LVAD or at the time of left ventricular aneurysectomy which is a substrate for VT.[5][6]
Autonomic Modulation
- VT or VF may be provoked by Sympathetic activation and maybe inhibited by parasympathetic activity.
- Prevention of ventricular arrhythmia can be done by interruption of sympathetic outflow to the heart, pharmacological beta-blockade, or through stimulation of the parasympathetic pathway (vagal nerve stimulators, spinal cord stimulators).
- Autonomic modulation is effective in conditions such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.
- Efficacy for ventricular tachycardia is under investigation.
- Atenolol was effective for controlling symptomatic ventricular tachycardia.
- The efficacy of bilateral cardiac sympathetic denervation has been shown for VT, or VF storm refractory to treatment (medications, catheter ablation)
References
- ↑ Cook, James R.; Rizo-Patron, Carlos; Curtis, Anne B.; Gillis, Anne M.; Bigger, J.Thomas; Kutalek, Steven P.; Coromilas, James; Hofer, Bradley I.; Powell, Judy; Hallstrom, Alfred P. (2002). "Effect of surgical revascularization in patients with coronary artery disease and ventricular tachycardia or fibrillation in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Registry". American Heart Journal. 143 (5): 821–826. doi:10.1067/mhj.2002.121732. ISSN 0002-8703.
- ↑ Milojevic, Milan; Head, Stuart J.; Parasca, Catalina A.; Serruys, Patrick W.; Mohr, Friedrich W.; Morice, Marie-Claude; Mack, Michael J.; Ståhle, Elisabeth; Feldman, Ted E.; Dawkins, Keith D.; Colombo, Antonio; Kappetein, A. Pieter; Holmes, David R. (2016). "Causes of Death Following PCI Versus CABG in Complex CAD". Journal of the American College of Cardiology. 67 (1): 42–55. doi:10.1016/j.jacc.2015.10.043. ISSN 0735-1097.
- ↑ Every, Nathan R.; Fahrenbruch, Carol E.; Hallstrom, Alfred P.; Weaver, W.Douglas; Cobb, Leonard A. (1992). "Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out of hospital cardiac arrest". Journal of the American College of Cardiology. 19 (7): 1435–1439. doi:10.1016/0735-1097(92)90599-I. ISSN 0735-1097.
- ↑ Taylor, Allen J.; Rogan, Kevin M.; Virmani, Renu (1992). "Sudden cardiac death associated with isolated congenital coronary artery anomalies". Journal of the American College of Cardiology. 20 (3): 640–647. doi:10.1016/0735-1097(92)90019-J. ISSN 0735-1097.
- ↑ Sartipy, Ulrik; Albåge, Anders; Strååt, Eva; Insulander, Per; Lindblom, Dan (2006). "Surgery for Ventricular Tachycardia in Patients Undergoing Left Ventricular Reconstruction by the Dor Procedure". The Annals of Thoracic Surgery. 81 (1): 65–71. doi:10.1016/j.athoracsur.2005.06.058. ISSN 0003-4975.
- ↑ Mulloy, Daniel P.; Bhamidipati, Castigliano M.; Stone, Matthew L.; Ailawadi, Gorav; Bergin, James D.; Mahapatra, Srijoy; Kern, John A. (2013). "Cryoablation during left ventricular assist device implantation reduces postoperative ventricular tachyarrhythmias". The Journal of Thoracic and Cardiovascular Surgery. 145 (5): 1207–1213. doi:10.1016/j.jtcvs.2012.03.061. ISSN 0022-5223.