Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia.

Abstract

Denervation of the extrinsic cardiac sympathetic nervous system is a method of altering the autonomic tone experienced by the heart and vasculature. It has been studied and employed as a therapy for cardiac disease for decades. Currently, there is a high level of interest in using cardiac denervation for treatment of arrhythmias. This review describes the anatomy and physiology of the cardiac autonomic nervous system followed by a discussion of the mechanistic studies which provide a basis for the therapeutic use of sympathetic denervation. The clinical research supporting its use in human arrhythmias is then appraised, covering the standard indications, such as long QT syndrome, as well as future possibilities. Last, a detailed account of the methods for performing surgical cardiac denervation and percutaneous stellate ganglion anesthetic block is provided, including the complications of each procedure. An understanding of the anatomy and physiology of the cardiac autonomic nervous system along with the techniques of surgical denervation and percutaneous anesthetic block will allow the clinician to effectively discuss and implement these therapies.

• Authors: Chance M Witt, Luciana Bolona, Michelle O Kinney, Christopher Moir, Michael J Ackerman, Suraj Kapa, Samuel J Asirvatham, Christopher J McLeod
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 19 Issue 7 Pg. 1075-1083 (Jul 01 2017) ISSN: 1532-2092 [Electronic] England
• PMID: 28340164 (Publication Type: Journal Article, Review)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: [email protected].

Chemical References

• Anesthetics, Local

Topics

• Anesthetics, Local (administration & dosage, adverse effects)
• Animals
• Arrhythmias, Cardiac (diagnostic imaging, physiopathology, surgery)
• Autonomic Nerve Block (adverse effects, methods)
• Heart (innervation)
• Heart Rate
• Humans
• Injections
• Stellate Ganglion (drug effects, physiopathology)
• Sympathectomy (adverse effects, methods)
• Sympathetic Nervous System (physiopathology, surgery)
• Treatment Outcome