Atrial flutter is uncommon in young patients with uncorrected atrial septal defect (ASD). Although rare, it has been reported in the younger population following device closure of ASD/patent foramen ovale. We describe a case of persistent atypical atrial flutter following device closure of ASD in a young man and discuss the management strategy given the various underlying dilemmas.

Background Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long‐term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA. Methods We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT. Results A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow‐up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter‐defibrillator (ICD) or external defibrillator shocks post‐CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint. Conclusion The current retrospective analysis re‐emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.

Background: Cardiac Sympathetic Denervation (CSD) involves surgical removal of lower half of the stellate ganglion and the T1-T4 ganglia for reducing sympathetic discharge to the heart. CSD is a useful therapeutic option in patients with ventricular tachycardia (VT) when they are non-responsive to standard drug therapy or catheter ablation. We report here the clinical profile and long-term outcome of all our patients who underwent CSD for refractory VT or VT storm. Method: Data of all patients who underwent CSD from 2010 to 2019 was analysed. They were regularly followed up, focusing on arrhythmia recurrence. Complete response to CSD was defined as more than 75% decrease in the frequency of VT. Results: A total of 65 patients (50 male, 15 female) underwent CSD in the above-mentioned period and the duration of follow-up was 27±24 months.The underlying substrate was for VT was coronary artery disease in 30 (46.2%) patients and 35 (53.8%) patients had a variety of other causes. Complete response to CSD was attained in 47 (72.3%) patients. There was a significant decline in the incidence of number shocks after CSD (24±37 vs 2±4; p <0.01). Freedom from a combined end point of ICD shock or death at the end of two years was 51.5%. Advanced NYHA class (III and IV) was the only parameter shown to have significant association with this combined end point. Conclusion: The current retrospective analysis reemphasize the role of surgical CSD in the treatment of patients with refractory VT or VT storm.