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Introduction: Cardiac sympathetic denervation (CSD) is considered in the management of patients with refractory ventricular arrhythmias or storm. It has been shown to decrease the burden of ventricular arrhythmias and the ICD shocks acutely in previous studies, however, follow-up data is still limited. Hypothesis: The purpose of this study is to evaluate ventricular tachycardia (VT) recurrence within a 6-month period after CSD. Methods: We analyzed all patients who underwent CSD at the University of Florida hospital between 2011 to 2017. The primary outcome was the recurrence of sustained VT at 6 months. The burden of ICD shocks, the need for VT ablation/redo ablation, and cardiovascular-related mortality in the first 6 months were also reported. Results: A total of 29 patients with CSD were included (9 patients had left CSD and 20 patients had bilateral CSD, mean age 60.1±11.5, 86 % male, and EF 27.3±15.4% by 2D-echocardiography), 13 (44.8%) of them presented with VT storm and 15 (51.7%) had prior VT ablation. One patient had cardiovascular-related mortality by 1 month and 7 patients by 6 months. The rate of VT recurrence was 31% by 1 month and increased to 35% by 6 months. By the end of the follow-up period, 17 (58.6%) patients remained free of recurrent ICD shocks and VT ablation was needed in 12 (41.4%) patients, 6 of them were redo-ablations. We further divided patients based on the underlying heart disease including ischemic heart disease (HD) and non-ischemic HD and there was no difference in the rate of VT recurrence at 6 months (p=0.18). There was also no difference in the primary outcome between left only CSD and bilateral CSD (P=0.98). Conclusions: Our data show that CSD showed benefit in VT recurrence rate at 6 months post-procedure. Reduction and freedom of ICD shocks were noted in patients with refractory VT or electrical storm. These benefits were independent of the underlying heart disease etiology. More studies with a longer follow-up period are warranted to confirm these results and follow long-term outcomes.

Background: Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are an unfortunately but luckily relatively uncommon complication of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences. Objective: Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success. Methods: A comprehensive literature search was undertaken to formulate this narrative review. Results: This review highlights the complex nature of PVL and the promising contemporary treatments available. Conclusion: Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.