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Targeted ablation of cardiac sympathetic neurons: A promising approach to prevent sudden cardiac death.

Targeted ablation of cardiac sympathetic neurons: A promising approach to prevent sudden cardiac death.

Xia W, Liu Y (2016) Targeted ablation of cardiac sympathetic neurons: A promising approach to prevent sudden cardiac death. Int J Cardiol 202:425-426. doi: 10.1016/j.ijcard.2015.09.049

Summary: Sudden cardiac death (SCD) refers to an unexpected death due to cardiovascular causes, occurring generally within 1 hr of symptom onset, in a person without any prior condition that would appear fatal. Currently, the implantable cardioverter-defibrillator (ICD) has been shown to be the most effective therapy for preventing SCD. However, the occurrence of lead complications is significant and more importantly, the ICD implantation remains costly and the quality of life for recipients is significantly affected with appropriate and inappropriate shocks. Sympathetic activation plays an important role in the pathophysiology of arrhythmias leading to SCD, and neuraxial modulation is emerging as an important avenue of therapeutic intervention. The authors demonstrate that targeted ablation of cardiac sympathetic neurons by bilateral stellate ganglia injection of CTB-SAP (Cat. #IT-14) is a novel method for sympathetic blockade. CTB-SAP will be retrogradely transported to the plasma membranse of sympathetic preganglionic neurons (SPNs) and bind to the GM1 gangliosides and subsequently ablate these neurons. Targeted ablation of cardiac sympathetic neurons by injection of CTB-SAP avoids the limitations of medical therapy and thoracic sympathectomy, such as incomplete compliance, Horner’s syndrome, and compensatory hyperhidrosis. Furthermore, they found that targeted ablation of cardiac sympathetic neurons reduces resting, reflex and exercise-induced sustained ventricular tachycardia, associated with a reduced number of neurons in the stellate ganglia and spinal cord, as well as a reduced left ventricular norepinephrine content and sympathetic innervation density. Therefore, targeted ablation of cardiac sympathetic neurons may be a promising approach to prevent SCD via regulating the cardiac autonomic nervous system.