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The Cutting Edge

Snipping Key Nerves May Help Life-Threatening Arrhythmias

Illustration from Anatonmia UniverseaHyperhidrosis, an abnormal flight-or-fight response of the sympathetic nervous system that causes excessively sweaty palms, may also contribute to problems like dangerous irregular rhythms from the lower chambers of the heart, known as ventricular arrhythmias.

UCLA cardiologists have now found that surgery to snip nerves associated with the sympathetic nervous system on both the left and right sides of the chest may be helpful in stopping dangerous, incessant ventricular arrhythmias - known as an "electrical storm" - when other treatment methods have failed. This same surgery has been used for years to alleviate hyperhidrosis.

The study, published in the Journal of the American College of Cardiology, is among the first to assess the impact of bilateral cardiac sympathetic denervation (BCSD), surgery on both sides of the heart, to control arrhythmias. The research builds on previous work at UCLA in which a similar procedure was performed only on the left side. But for some patients to obtain relief, the researchers said, it must be done bilaterally.
Kalyanam Shivkumar, M.D., Ph.D.
Arrhythmias can usually be controlled by using medications, an implantable cardioverter defibrillator that automatically shocks the heart back into normal rhythm, or a procedure called catheter ablation, which involves a targeted burn to the tiny area of the heart causing the irregular heart beat. But when these treatment options fail, the situation becomes critical, says Kalyanam Shivkumar, M.D., Ph.D., director of the UCLA Cardiac Arrhythmia Center and co-director of the Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress at UCLA. "We are always seeking additional options to help patients."

The UCLA findings add to a growing field of research on the sympathetic nervous system's impact on stress and its possible role in disease. Dr. Shivkumar notes that this research may provide a unique opportunity; if snipping the cardiac sympathetic nerve proves to effectively alleviate irregular heart rhythms, perhaps the treatment could be initiated early, before the condition manifests itself.


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