Snipping Adrenaline Nerve May Heal Deadly Heart Arrhythmia

An operation to clip a nerve associated with the body's adrenaline-fueled "flight or fight" reaction may successfully heal potentially life-threatening heart arrhythmias.

Surgery to cut nerves related to the sympathetic nervous system on both the left and right sides of the chest may stop dangerous incessant ventricular arrhythmias called an electrical storm.

In previous research the procedure was performed on only one side the heart, but some patients may need surgery on both sides, called bilateral cardiac sympathetic denervation (BCSD), to obtain relief.

The same procedure has been used for many years to alleviate excessive sweaty palms from an abnormal flight or fight response.

Senior study author Dr. Kalyanam Shivkumar, director of the University of California Los Angeles' Cardiac Arrhythmia Center and co-director of the Oppenheimer Family Center for Neurobiology of Stress at UCLA, noted that when other treatment options fail, the situation becomes critical, especially for patients experiencing a life-threatening electrical storm. He said the new study was borne from a desire to offer more options to aid patients with dangerous arrhythmias.

Dangerous heart arrhythmias are usually controlled by medication, an implantable defibrillator capable of automatically shocking the heart as needed, or catheter ablation, which can stop the abnormal heart rhythm with a targeted burn to the heart.

During the small trial at a center in France, researchers performed  the BCSD procedure on six patients that had presented with an electrical storm with an average age of 60. The participants were poor candidates for a heart transplant and had previously tried other treatment, which had failed.

The procedure requires snipping the stellate ganglia, part of the sympathetic nervous system that delivers information to the body about stress and initiates the “flight or fight” response, and three ganglias below it. This completely removes nerves traveling from the sympathetic nervous system to the heart.

Following the operation, four of the six patients no longer had a heart arrhythmia. One patient was aided partially, and the sixth did not respond to the operation.

Three of the patients that responded to the procedure no longer received shocks from their implantable defibrillators, including one patients who had previously received about 11 shocks a day. The patient who responded partially to treatment saw a 50 percent reduction in the number of shocks received. Two patients died after hospital discharge to health issues not related to their heart arrhythmias.

Researchers believe the procedure to cut the nerve could be offered as an early treatment before the disease manifests itself. They plan to study the dual procedure with a larger future trial.

The findings will be published later this month in the Journal of the American College of Cardiology.