Ventricular tachycardia surgery
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Ventricular tachycardia Microchapters |
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Differentiating Ventricular Tachycardia from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Ventricular tachycardia surgery On the Web |
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Risk calculators and risk factors for Ventricular tachycardia surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Zand, M.D.[2]
Overview
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. For patients with ischemic heart disease and reduced LVEF undergoing CABG, the risk of sudden cardiac death lessened compared with medical therapy. Among survival of SCD, the risk of death reduced by revascularization procedure including PCI or CABG. 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. Revascularization is recommended for treating ischemia leading life-threatening ventricular arrhythmia due to anomalous aortic origin of the coronary arteries. 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. VT or VF maybe 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 in patients without structural heart disease.
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 maybe 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).[7]
- 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 in patients without structural heart disease.[8]
- The efficacy of bilateral cardiac sympathetic denervation has been shown for VT, or VF storm refractory to treatment (medications, catheter ablation).[7]
2017 AHA/ACC/HRS Guideline for management of ventricular arrhythmias
| Recommendations for surgery or revascularization procedures in patients with ventricular tachycardia |
| Recommendation for revascularization in patients with Ischemic Heart Disease (Class I, Level of Evidence B) |
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❑ Evaluation about ischemic heart disease and appropriate revascularization in patients with sustained VT or survivors of SCA |
| (Class I, Level of Evidence C) |
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❑ Repair or revascularization in patients with anomalous coronary arteries origin suspected to be the cause of SCA |
| Recommendation for surgical ablation for arrhythmia management : (Class IIb, Level of Evidence C) |
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❑ Surgical ablation is recommended in patients with monomorphic VT refractory to the medications or catheter ablation |
| Recommendation for Autonomic modulation : (Class IIa, Level of Evidence C) |
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❑ Betablocker is recommended in patients with symptomatic non-life threatening ventricular arrhythmia |
| (Class IIb, Level of Evidence C) |
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❑ Cardiac sympathetic denervation is recommended in patients with refractory ventricular tachycardia to betablocker, antiarrhythmic drugs, catheter ablation |
| The above table adopted from 2017 AHA/ACC/HRS Guideline |
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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.
- ↑ 7.0 7.1 Vaseghi, Marmar; Gima, Jean; Kanaan, Christopher; Ajijola, Olujimi A.; Marmureanu, Alexander; Mahajan, Aman; Shivkumar, Kalyanam (2014). "Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: Intermediate and long-term follow-up". Heart Rhythm. 11 (3): 360–366. doi:10.1016/j.hrthm.2013.11.028. ISSN 1547-5271.
- ↑ Krittayaphong, Rungroj; Bhuripanyo, Kiertijai; Punlee, Kesaree; Kangkagate, Charuwan; Chaithiraphan, Suphachai (2002). "Effect of atenolol on symptomatic ventricular arrhythmia without structural heart disease: A randomized placebo-controlled study". American Heart Journal. 144 (6): 1–5. doi:10.1067/mhj.2002.125516. ISSN 0002-8703.
- ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.