Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia.
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.
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Chance M
CM
Witt
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Luciana
L
Bolona
Department of Anesthesiology Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Michelle O
MO
Kinney
Department of Pediatric Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Christopher
C
Moir
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Michael J
MJ
Ackerman
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Suraj
S
Kapa
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Samuel J
SJ
Asirvatham
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Christopher J
CJ
McLeod
D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D000818:Animals; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods*; D006321:Heart / Q000294:innervation*; D006339:Heart Rate; D006801:Humans; D007267:Injections; D013233:Stellate Ganglion / Q000187:drug effects* / Q000503:physiopathology; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013564:Sympathetic Nervous System / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
D000779:Anesthetics, Local
Arrhythmia ; Autonomic nervous system ; Cardiac sympathetic denervation ; Stellate ganglion block ; Ventricular tachycardia