心脏去交感神经术在恶性室性心律失常中的应用

Cardiac sympathetic denervation for maglignant ventricular arrhytmias

恶性室性心律失常包括器质性和遗传性两大类,可导致猝死严重危害人类健康.这些心律失常发生多与心脏交感神经激活有关.心脏交感神经切除术(CSD)通过切除下半部分星状神经节和前四对胸交感神经节可降低心脏交感神经活性,是恶性室性心律失常有效、安全的治疗手段.对于长QT综合征和儿茶酚胺敏感性多形性室性心动过速(CPVT),单纯左侧CSD可能就已足够;对于器质性心脏病合并室性心律失常,双侧CSD可能具有更好疗效.

Malignant ventricular arrhythmias(VAs)are composed of structural and inherited ventricular arrhythmias,which are a major cause of sudden cardiac death.It has been long recognized that the sympathetic activation plays a key role in the initiation and perpetuation of these malignant VAs.Cardiac sympathetic denervation(CSD)is a surgical procedure that removes the lower third to half of the sellate ganglia and T2-T4 thoracic ganglia.Some evidence supports that CSD may be more efctive at preventing recurrent VAs.It seems that for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia(CPVT)left CSD alone is enough,however,for VAs with structural heart disease,bilateral CSD may be requisite.