Two patients had bilateral cervico-thoracic sympatho-ganglionectomy for treatment of disabling symptoms due to refractory ventricular tachycardia. In both patients treatment with antiarrhythmic drugs singly, in combination, or together with pacemaker overdrive had been ineffective in controlling this arrhythmia.Both patients had normal coronary arteriograms.Bilateral thoracic svmpathectomv appears to facilitate medical management of ventricular tachycardia in selectecl patients wx ho are refractorv to the usual medical treatment. Additional Indexing Words:Refractorv ventricular tachvcardia Thoracic svmpathectomv RECURRENT VENTRICULAR TACHYCARDIA not associated with coronary disease is uncommon. There have been sporadic reports of ventricular tachycardia without other evidence of heart disease, and Lesch et al. collected 34 reports of such patients between ages 2 and 40.1 This report relates our recent experience with two patients who had normal coronary arteriograms and who had recurrent incapacitating ventricular tachycardia, which proved refractory to conventional measures. NMedical management of their arrhythmias was facilitated by bilateral cervico-thoracic sympathetic ganglionectomy. Prior experience with sympathectomy in this situation is reviewed. Case ReportsCase 1 Patient M.E., a 48-year-old Caucasian housewife, was first admitted to the Arizona Medical Center on July 24, 1973.The patient was in good health until one week prior to ad-Fromn the Sections of Cardiology and Cardiovascular Surgery,

Background Community health worker (CHW) motivation is an important factor related to health service quality and CHW program sustainability in low- and middle-income countries. Financial and non-financial motivators may influence CHW behavior through two dimensions of motivation: desire to perform and effort expended. The aim of this study was to explore how the removal of performance-based financial incentives impacted CHW motivation after formal funding ceased for Alive and Thrive (A&T), an infant and young child feeding (IYCF) program in Bangladesh. Methods This qualitative study included seven focus groups (n = 43 respondents) with paid supervisors of volunteer CHWs tasked with delivering interpersonal IYCF counseling services. Data were transcribed, translated into English, and then analyzed using both a priori themes and a grounded theory approach. Results Results suggest the removal of financial incentives was perceived to have negatively impacted CHWs’ desire to perform in three primary ways: 1) a decreased desire to work without financial compensation, 2) changes in pre- and post-intervention motivation, and 3) household income challenges due to dependence on incentives. Removal of financial incentives was perceived to have negatively impacted CHWs’ level of effort expended in four primary ways: 1) a reduction in CHW visits, 2) a reduction in quality of care, 3) CHW attrition, and 4) substitution of other income-generating activities. Conclusions This study provides new evidence regarding how removing performance-based financial incentives from a CHW program can negatively impact CHW motivation. The findings suggest that program decision makers should consider how to construct community health work programs such that CHWs may continue to receive performance-based compensation after the original funding ceases.