JACC. Case reports · 2026
Long-Term Heart Failure Stabilization and Autonomic Trends After Bilateral Cardiac Sympathetic Denervation.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Miki Yuko, Yoshimura Shingo, Sasaki Takehito, Kaseno Kenichi, Nakamura Kohki, Niwamae Nogiku, Kamiyoshihara Mitsuhiro, Naito Shigeto
Аннотация
BACKGROUND: Bilateral cardiac sympathetic denervation (CSD) is used for refractory ventricular tachycardia (VT); however, its effects on heart failure (HF) progression and left ventricular (LV) remodeling are unclear.
CASE SUMMARY: A 64-year-old man with ischemic cardiomyopathy was admitted for refractory monomorphic VT after 4 HF-related hospitalizations in the preceding year. Bilateral CSD for refractory VT eliminated HF-related hospitalizations for 32 months and was associated with LV reverse remodeling, with improved ejection fraction (20% → 30%) and reduced LV end-systolic volume index (66 → 50 mL/m2). 123I-metaiodobenzylguanidine scintigraphy demonstrated a reduced myocardial washout rate (62% → 52%). Beginning 28 months post procedure, implantable cardioverter-defibrillator diagnostics revealed a declining atrial pacing burden, suggesting attenuation of the sympatholytic effect and a preceding late VT storm with rapid HF deterioration.
DISCUSSION: CSD exerted a time-limited stabilizing effect on HF and VT.
TAKE-HOME MESSAGE: CSD may suppress HF progression and promote LV reverse remodeling. Implantable cardioverter-defibrillator-derived autonomic trends may indicate waning benefit.
CASE SUMMARY: A 64-year-old man with ischemic cardiomyopathy was admitted for refractory monomorphic VT after 4 HF-related hospitalizations in the preceding year. Bilateral CSD for refractory VT eliminated HF-related hospitalizations for 32 months and was associated with LV reverse remodeling, with improved ejection fraction (20% → 30%) and reduced LV end-systolic volume index (66 → 50 mL/m2). 123I-metaiodobenzylguanidine scintigraphy demonstrated a reduced myocardial washout rate (62% → 52%). Beginning 28 months post procedure, implantable cardioverter-defibrillator diagnostics revealed a declining atrial pacing burden, suggesting attenuation of the sympatholytic effect and a preceding late VT storm with rapid HF deterioration.
DISCUSSION: CSD exerted a time-limited stabilizing effect on HF and VT.
TAKE-HOME MESSAGE: CSD may suppress HF progression and promote LV reverse remodeling. Implantable cardioverter-defibrillator-derived autonomic trends may indicate waning benefit.