Clinical Management of Catecholaminergic Polymorphic Ventricular Tachycardia

Author:

De Ferrari Gaetano M.1,Dusi Veronica1,Spazzolini Carla1,Bos J. Martijn1,Abrams Dominic J.1,Berul Charles I.1,Crotti Lia1,Davis Andrew M.1,Eldar Michael1,Kharlap Maria1,Khoury Asaad1,Krahn Andrew D.1,Leenhardt Antoine1,Moir Christopher R.1,Odero Attilio1,Olde Nordkamp Louise1,Paul Thomas1,Rosés i Noguer Ferran1,Shkolnikova Maria1,Till Jan1,Wilde Arthur A.M.1,Ackerman Michael J.1,Schwartz Peter J.1

Affiliation:

1. From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,...

Abstract

Background— Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic disorder causing life-threatening arrhythmias whenever sympathetic activity increases. β-Βlockers are the mainstay of therapy; when they fail, implantable cardioverter-defibrillators (ICDs) are used but often cause multiple shocks. Preliminary results with flecainide appear encouraging. We proposed left cardiac sympathetic denervation (LCSD) as useful additional therapy, but evidence remains anecdotal. Methods and Results— We report 63 patients with CPVT who underwent LCSD as secondary (n=54) or primary (n=9) prevention. The median post-LCSD follow-up was 37 months. The 9 asymptomatic patients remained free of major cardiac events. Of the 54 patients with prior major cardiac events either on (n=38) or off (n=16) optimal medical therapy, 13 (24%) had at least 1 recurrence: 0 patients had an aborted cardiac arrest, 2 patients had syncope only, 10 patients had ≥1 appropriate ICD discharges, and 1 patient died suddenly. The 1- and 2-year cumulative event-free survival rates were 87% and 81%. The percentage of patients with major cardiac events despite optimal medical therapy (n=38) was reduced from 100% to 32% ( P <0.001) after LCSD, and among 29 patients with a presurgical ICD, the rate of shocks dropped by 93% from 3.6 to 0.6 shocks per person per year ( P <0.001). Patients with an incomplete LCSD (n=7) were more likely to experience major cardiac events after LCSD (71% versus 17%; P <0.01) than those with a complete LCSD. Conclusions— LCSD is an effective antifibrillatory intervention for patients with CPVT. Whenever syncope occurs despite optimal medical therapy, LCSD could be considered the next step rather than an ICD and could complement ICDs in patients with recurrent shocks.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference32 articles.

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2. Incidence and Risk Factors of Arrhythmic Events in Catecholaminergic Polymorphic Ventricular Tachycardia

3. Catecholaminergic Polymorphic Ventricular Tachycardia

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