Neuraxial Modulation for Electrical Storm

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Ventricular tachycardia (VT) contributes to significant morbidity and mortality for patients with structural heart disease. The implantable cardioverter-defibrillator (ICD) has been demonstrated to help in reducing mortality in this patient population. The ICD, however, cannot prevent future shocks and also contributes to significant anxiety for patients and is ineffective in the setting of VT/VF storm. Anti-arrhythmic drugs also have limited efficacy and are frequently not tolerated owing to various side effects. Catheter ablation of VT has now been shown to reduce recurrent VT episodes in numerous studies and has a role in VT/VF storm. Despite the advancements in VT ablation, specifically substrate modification, the interplay of the autonomic nervous system and development of VT is a growing avenue of research. Recent data suggest modulation of this system may terminate and prevent VT. Thoracic epidural anesthesia, left and bilateral stellate ganglionectomy are being studied for prevention of VT/VF episodes in humans. Further Reading: Bourke T, Vaseghi M, Michowitz Y, Sankhla V, Shah M, Swapna N, Boyle NG, Mahajan A, Narasimhan C, Lokhandwala Y, Shivkumar K. Neuraxial modulation for refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation. Circulation. 2010; 121(21): 2255–2262. Bourke T, Mathuria N, Michowitz Y, Shivkumar K. Hybrid techniques and neuraxial modulation for treatment of ventricular tachycardia. Future Cardiol. 2011; 7(3): 273–276.

Neuraxial Modulation for Electrical Storm

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