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Europace. 2017 Jul 1;19(7):1075-1083. doi: 10.1093/europace/eux011.

Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia.

Author information

1
Department of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
2
Department of Anesthesiology Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
3
Department of Pediatric Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.

Abstract

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.

KEYWORDS:

Arrhythmia ; Autonomic nervous system ; Cardiac sympathetic denervation ; Stellate ganglion block ; Ventricular tachycardia

PMID:
28340164
DOI:
10.1093/europace/eux011
[Indexed for MEDLINE]

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