Cardiac Sympathetic Innervation and Ablation of Ventricular Tachycardia

2016 ◽  
pp. 131-145
Author(s):  
John T. Duell ◽  
Thomas Klein ◽  
Mark F. Smith ◽  
Wengen Chen ◽  
Vasken Dilsizian ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Sympathetic Innervation ◽  
Cardiac Sympathetic Innervation

scholarly journals Cardiac sympathetic innervation via middle cervical and stellate ganglia and antiarrhythmic mechanism of bilateral stellectomy

2017 ◽  
Vol 312 (3) ◽  
pp. H392-H405 ◽  
Author(s):  
Tadanobu Irie ◽  
Kentaro Yamakawa ◽  
David Hamon ◽  
Keijiro Nakamura ◽  
Kalyanam Shivkumar ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Ventricular Fibrillation ◽  
Sympathetic Innervation ◽  
Sympathetic Activation ◽  
Hemodynamic Stability ◽  
Cardiac Sympathetic Innervation ◽  
Dispersion Of Repolarization ◽  
Stellate Ganglia ◽  
Cervical Ganglion ◽  
Cardiac Sympathetic Denervation

Cardiac sympathetic denervation (CSD) is reported to reduce the burden of ventricular tachyarrhythmias [ventricular tachycardia (VT)/ventricular fibrillation (VF)] in cardiomyopathy patients, but the mechanisms behind this benefit are unknown. In addition, the relative contribution to cardiac innervation of the middle cervical ganglion (MCG), which may contain cardiac neurons and is not removed during this procedure, is unclear. The purpose of this study was to compare sympathetic innervation of the heart via the MCG vs. stellate ganglia, assess effects of bilateral CSD on cardiac function and VT/VF, and determine changes in cardiac sympathetic innervation after CSD to elucidate mechanisms of benefit in 6 normal and 18 infarcted pigs. Electrophysiological and hemodynamic parameters were evaluated at baseline, during bilateral stellate stimulation, and during bilateral MCG stimulation in 6 normal and 12 infarcted animals. Bilateral CSD (removal of bilateral stellates and T2 ganglia) was then performed and MCG stimulation repeated. In addition, in 18 infarcted animals VT/VF inducibility was assessed before and after CSD. In infarcted hearts, MCG stimulation resulted in greater chronotropic and inotropic response than stellate ganglion stimulation. Bilateral CSD acutely reduced VT/VF inducibility by 50% in infarcted hearts and prolonged global activation recovery interval. CSD mitigated effects of MCG stimulation on dispersion of repolarization and T-peak to T-end interval in infarcted hearts, without causing hemodynamic compromise. These data demonstrate that the MCG provides significant cardiac sympathetic innervation before CSD and adequate sympathetic innervation after CSD, maintaining hemodynamic stability. Bilateral CSD reduces VT/VF inducibility by improving electrical stability in infarcted hearts in the setting of sympathetic activation. NEW & NOTEWORTHY Sympathetic activation in myocardial infarction leads to arrhythmias and worsens heart failure. Bilateral cardiac sympathetic denervation reduces ventricular tachycardia/ventricular fibrillation inducibility and mitigates effects of sympathetic activation on dispersion of repolarization and T-peak to T-end interval in infarcted hearts. Hemodynamic stability is maintained, as innervation via the middle cervical ganglion is not interrupted. Listen to this article's corresponding podcast at https://ajpheart.podbean.com/e/anti-arrhythmic-mechanism-of-bilateral-stellectomy/ .

scholarly journals Sympathetic innervation pattern in NICM patients with ventricular tachycardia -anteroseptal versus inferolateral substrates-

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
C Jungen ◽  
HS Chen ◽  
Y Kimura ◽  
P Dibbets-Schneider ◽  
SRD Piers ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Catheter Ablation ◽  
Sympathetic Innervation ◽  
Sympathetic Denervation ◽  
Mibg Imaging ◽  
German Research Foundation ◽  
Cardiac Sympathetic Innervation ◽  
National Budget ◽  
Segment Model ◽  
Public Grant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation - Projektnummer 447558597) Background Among patients with non-ischemic cardiomyopathy (NICM) two dominant ventricular tachycardia (VT) substrate locations, namely anteroseptal (AS) and inferolateral (IL), have been identified. The poor outcome after catheter ablation of AS substrates (ASS) compared to IL substrates (ILS) has been attributed to its deep intramural location. However, region specific tissue charateristics, including sympathetic innervation, as important determinant of arrhythmogeneity, may also contribute to the outcome disparity. Aim To evaluate the association between regional sympathetic denervation, myocardial fibrosis and VT substrates according to two dominant VT substrate locations. Methods Twenty-nine patients from the ‘Leiden Nonischemic Cardiomyopathy Study’, who underwent electroanatomical substrate mapping and radiofrequency catheter ablation (RFCA), LGE-CMR and 123-I-MIBG imaging between 2011-2018 were included. The 16-segment model was used to describe the distribution of endocardial low unipolar voltage (UV <25th IQR) (=electroanatomical surrogate for fibrosis), the location of abnormal local electrograms and VT related sites (= surrogate for VT substrate) and the presence of LGE. Regional cardiac sympathetic innervation was determined by 123-I-MIBG imaging and analyzed according to the 16-segment model. Regions with sympathetic denervation were correlated with low UV areas, VT substrate location and LGE. Patients were categorized according to the dominant VT substrate location in ASS or ILS. Results Ten patients had a dominant ASS, 12 patients a dominant ILS and 1 patient had ASS and ILS; 6 patients had other VT substrate locations. All but one patient with ASS and one with ILS also showed corresponding low UV (=surrogate for fibrosis) in segments with VT substrates. Eight patients with IL VT substrates but only 4 with AS substrates showed corresponding LGE in the VT related segments. All patients with inferolateral VT substrates showed sympathetic denervation in IL segments (100% matching segments), but only 3/11 (27%) with anteroseptal substrates had sympathetic denervation in AS segments (P = 0.0002). UV was not significantly different between matching (VT substrate and denervation) and not matching ASS segments (5.74 ± 2.69 mV vs. 4.64 ± 1.85 mV, P = 0.78) and between matching ASS and ILS segments (5.74 ± 2.69 mV vs. 7.61 ± 2.91, P = 0.43). LGE location was matching with sympathetic denervation in all patients with ILS but only in 33% of patients with ASS. Conclusion Despite low endocardial UV (=surrogate for fibrosis) for AS and IL segments harboring VT substrates, regional sympathetic denervation coincided with fibrosis only for IL VT substrates. The mismatch between regional fibrosis and preserved innervation for AS VT substrates may contribute to a VT substrate difficult to control by RFCA.

Evaluation of regional cardiac sympathetic innervation in congenital long QT syndrome using 123I-MIBG scintigraphy

1998 ◽  
Vol 19 (10) ◽  
pp. 943-952 ◽  
Author(s):  
M. MOMOSE ◽  
H. KOBAYASHI ◽  
H. KASANUKI ◽  
K. KUSAKABE ◽  
A. TAMAKI ◽  
...  
Keyword(s):  
Long Qt Syndrome ◽  
Sympathetic Innervation ◽  
Mibg Scintigraphy ◽  
Long Qt ◽  
Cardiac Sympathetic Innervation ◽  
Qt Syndrome ◽  
Congenital Long Qt Syndrome

scholarly journals 216-69: Does cardiac sympathetic innervation predict changes in arterial stiffness in heart failure after Cardiac Resynchronization therapy?

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i159-i159
Author(s):  
João Frutuoso ◽  
Ana Abreu ◽  
Luis Almeida Morais ◽  
Inês Rodrigues ◽  
Guilherme Portugal ◽  
...  
Keyword(s):  
Heart Failure ◽  
Arterial Stiffness ◽  
Cardiac Resynchronization Therapy ◽  
Sympathetic Innervation ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardiac Sympathetic Innervation

scholarly journals Рositron emission tomography in assessment of heart sympathetic nervous system

2008 ◽  
Vol 14 (4) ◽  
pp. 347-355
Author(s):  
D. Ryzhkova ◽  
E. M. Zykov ◽  
E. V. Shlyakhto
Keyword(s):  
Nervous System ◽  
Heart Diseases ◽  
Sympathetic Innervation ◽  
Cardiovascular Complications ◽  
Emission Tomography ◽  
Good Tool ◽  
Technical Aspects ◽  
Cardiac Sympathetic Innervation ◽  
Positron Emission ◽  
Sympathetic Nervous

This article summarizes data of the studies with the use of positron emission tomography (PET) and devotes technical aspects and clinical application of PET for assessment of the autonomic nervous system of the heart in patients with cardiac diseases. According to the results of experimental and clinical studies PET with radiolabeled сatecholamines and adrenoreceptor ligands provides us with information about alteration of cardiac sympathetic innervation at different steps of neurotransmission. It plays a key role in the progression of various heart diseases such as ischemia, diabetes mellitus, heart failure and noncoronary arrhythmia. Cardiac sympathetic neuronal PET imaging seems to be a good tool for the stratification of the risk of the severe cardiovascular complications.

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