Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation

Fabrizio R. Assis; Diana H. Yu; Xun Zhou; Sunjeet Sidhu; Anisha Bapna; Zoar J. Engelman; Satish Misra; David R. Okada; Jonathan Chrispin; Ronald Berger; Kaushik Mandal; Hans Lee; Harikrishna Tandri

doi:10.1016/j.hrthm.2018.07.037

Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation

Fabrizio R. Assis, Diana H. Yu, Xun Zhou, Sunjeet Sidhu, Anisha Bapna, Zoar J. Engelman, Satish Misra, David R. Okada, Jonathan Chrispin, Ronald Berger, Kaushik Mandal, Hans Lee, Harikrishna Tandri

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Background: Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. Objective: The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. Methods: In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. Results: Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dT_max (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. Conclusion: Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.

Original language	English (US)
Pages (from-to)	117-124
Number of pages	8
Journal	Heart Rhythm
Volume	16
Issue number	1
DOIs	https://doi.org/10.1016/j.hrthm.2018.07.037
State	Published - Jan 2019

All Science Journal Classification (ASJC) codes

Cardiology and Cardiovascular Medicine
Physiology (medical)

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10.1016/j.hrthm.2018.07.037

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@article{51549ef30f40435ebf4c51b6f3a264c8,

title = "Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation",

abstract = "Background: Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. Objective: The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. Methods: In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. Results: Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dTmax (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. Conclusion: Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.",

author = "Assis, {Fabrizio R.} and Yu, {Diana H.} and Xun Zhou and Sunjeet Sidhu and Anisha Bapna and Engelman, {Zoar J.} and Satish Misra and Okada, {David R.} and Jonathan Chrispin and Ronald Berger and Kaushik Mandal and Hans Lee and Harikrishna Tandri",

note = "Publisher Copyright: {\textcopyright} 2018 Heart Rhythm Society",

year = "2019",

month = jan,

doi = "10.1016/j.hrthm.2018.07.037",

language = "English (US)",

volume = "16",

pages = "117--124",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation

AU - Assis, Fabrizio R.

AU - Yu, Diana H.

AU - Zhou, Xun

AU - Sidhu, Sunjeet

AU - Bapna, Anisha

AU - Engelman, Zoar J.

AU - Misra, Satish

AU - Okada, David R.

AU - Chrispin, Jonathan

AU - Berger, Ronald

AU - Mandal, Kaushik

AU - Lee, Hans

AU - Tandri, Harikrishna

PY - 2019/1

Y1 - 2019/1

N2 - Background: Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. Objective: The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. Methods: In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. Results: Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dTmax (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. Conclusion: Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.

AB - Background: Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea. Objective: The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models. Methods: In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline. Results: Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dTmax (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures. Conclusion: Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.

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U2 - 10.1016/j.hrthm.2018.07.037

DO - 10.1016/j.hrthm.2018.07.037

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SN - 1547-5271

VL - 16

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EP - 124

JO - Heart Rhythm

JF - Heart Rhythm

IS - 1

ER -

Minimally invasive transtracheal cardiac plexus block for sympathetic neuromodulation

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