VENTRICULAR ARRHYTHMIAS – abnormal rhythms from the lower chambers of the heart – are typically treated using a combination of medication, implanted defibrillators and catheter ablation; however, for a small subset of patients, such as those who experience a ventricular electrical storm (three or more episodes within a 24-hour period), such arrhythmias pose serious medical emergencies and require further treatment.
In a study published in the June 2010 issue of Circulation, cardiologists at the UCLA Cardiac Arrhythmia Center used two newer therapies to control these life-threatening arrhythmias. One is thoracic epidural anesthesia, which is applied with a small catheter between discs in the upper spinal cord and can be used as a bridge to catheter ablation or cardiac transplant. The other is left cardiac sympathetic denervation, an additional treatment for select patients that involves endoscopic interruption of the nerves that come out of the spinal cord and give rise to fibers that reach the heart.
They found that the methods may effectively reduce signals from the central nervous system to the heart, which can control or stop the arrhythmias. The procedures were well-tolerated and may provide a new approach in treatment by helping modulate the central nervous system.
The next step is further evaluation in randomized clinical trials. A large study is currently being led by the team at UCLA, in collaboration with researchers at the Mayo Clinic and centers in Italy and India.