Management of life-threatening ventricular arrhythmias: what is going on with autonomic neuromodulation

Abstract

Electrical storm (ES), characterized by recurrent and frequent episodes of potentially life-threatening ventricular arrhythmias (VA), is a relatively common condition, primarily seen in patients with structural heart disease and implantable cardioverter-defibrillators (ICD). It is a complex severe clinical situation, associated with high mortality and low quality of life. Electrical storm management has evolved over the years, with anti-arrhythmic drugs, introduced in the 1950s, followed by the ICD in the 1980s. In the 21st century, radiofrequency catheter ablation, three-dimensional electroanatomic mapping and advanced cardiac imaging have provided a better understanding of the arrhythmic mechanisms, allowing substrate modification, and refining ES management. However, ES is still associated with significant residual morbidity and mortality. In recent years, more attention has been given to autonomic nervous system dysregulation as a perpetrator of arrhythmias, and to the role of innovative techniques of neuromodulation in the prevention and treatment of refractory recurrent VA.