Abstract:
BACKGROUND:Novel therapies aimed at modulating the autonomic nervous system, including thoracic epidural anesthesia (TEA), have been shown in small case series to be beneficial in treating medically refractory ventricular tachycardia (VT) storm. However, it is not clear when these options should be considered. We reviewed a multicenter experience with TEA in the management of VT storm to determine its optimal therapeutic use. METHODS AND RESULTS:Data for 11 patients in whom TEA was instituted for VT storm between July 2005 and March 2016 were reviewed to determine the clinical characteristics, outcomes, and role in management. The clinical presentation was incessant VT in 7 (64%), with polymorphic VT in 3 (27%) and monomorphic VT in 8 (73%). The underlying conditions were nonischemic cardiomyopathy in 5 (45%), ischemic cardiomyopathy in 3 (27%), and hypertrophic cardiomyopathy, Brugada syndrome, and cardiac lipoma in 1 (9%) each. Five (45%) had a complete and 1 (9%) had a partial response to TEA; 4 of the complete responders had incessant VT. All 4 patients with a documented response to deep sedation demonstrated a complete response to TEA. CONCLUSIONS:More than half of the patients with VT storm in our series responded to TEA. TEA may be effective and should be considered as a therapeutic option in patients with VT storm, especially incessant VT, who are refractory to initial management. Improvement in VT burden with deep sedation may suggest that sympathoexcitation plays a key role in perpetuating VT and predict a positive response to TEA.
journal_name
J Am Heart Assocjournal_title
Journal of the American Heart Associationauthors
Do DH,Bradfield J,Ajijola OA,Vaseghi M,Le J,Rahman S,Mahajan A,Nogami A,Boyle NG,Shivkumar Kdoi
10.1161/JAHA.117.007080subject
Has Abstractpub_date
2017-10-27 00:00:00issue
11issn
2047-9980pii
JAHA.117.007080journal_volume
6pub_type
杂志文章,多中心研究abstract:BACKGROUND:The MMP (matrix metalloproteinase) family plays diverse and critical roles in directing vascular wall remodeling in atherosclerosis. Unlike secreted-type MMPs, a member of the membrane-type MMP family, MT1-MMP (membrane-type 1 MMP; MMP14), mediates pericellular extracellular matrix degradation that is indisp...
journal_title:Journal of the American Heart Association
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journal_title:Journal of the American Heart Association
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abstract:BACKGROUND:Preeclampsia (PE) is a life-threatening hypertensive disorder of pregnancy associated with autoantibodies, termed AT1-AA, that activate the AT1 angiotensin receptor. Although the pathogenic nature of these autoantibodies has been extensively studied, little is known about the molecular cause of their generat...
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2021-01-05 00:00:00
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pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2018-11-20 00:00:00
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pub_type: 杂志文章,多中心研究
doi:10.1161/JAHA.115.002997
更新日期:2016-02-23 00:00:00
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