Cardiac sympathetic denervation for conventional treatment refractory arrhythmias

Abstract

Objective: Cardiac sympathetic denervation (CSD) using video-assisted thoracoscopy is a therapeutic alternative for cardiac arrhythmias refractory to conventional treatment in patients with ventricular structural heart disease, mainly due to ischemia, and in patients with hereditary conditions associated with sudden death such as long QT syndrome. In general, it is performed in cases with recurrent episodes of ventricular tachycardia or electrical storm, in spite of conventional treatment. The objective of this study is to show the experience of this institution with DSCI in refractory patients to conventional management and the results derived from its application. Methods: This was an observational retrospective study. The records of patients with a history of ventricular arrhythmias treated in our center with pharmacological treatment, catheter ablation, or implantation of an implantable cardioverter-defibrillator (ICD), who underwent video-assisted CSD were analyzed and described. Results: A total of six patients were included in the study. Patients with structural heart disease were the most frequent, median age was 56 ± 16 years; 67% were male. The procedure evolved without complications in any of the patients and an overall significant improvement was observed. A 24-month follow-up was conducted; two patients had recurrence episodes presenting as slow ventricular tachycardia without severe symptoms and a third patient presented an episode of ventricular fibrillation aborted by the ICD. Conclusion: Video-assisted CSD should be considered as a treatment option for patients with potentially dangerous arrhythmias that do not respond to conventional treatment, especially in recurrent ventricular tachycardia.

Cardiac Sympathetic Denervation as a Treatment for Ventricular Arrhythmias Refractory to Conventional Treatment: A Case Series

“…16 The other, a case series of six patients in the city of Cali, reported a decrease of symptoms in four patients. 17 Other studies have reported effectiveness ranging from 70% to 80% within the first month to the first year after VAT-CSD. [18][19][20][21][22] This study evaluated symptom control by measuring the mean number of ICD shocks in the month before and after surgery, as well as ED visits related to arrhythmia before and after VAT-CSD.…”

“…[ 16 ] The other, a case series of six patients in the city of Cali, reported a decrease of symptoms in four patients. [ 17 ] Other studies have reported effectiveness ranging from 70% to 80% within the first month to the first year after VAT-CSD. [ 18 – 22 ]…”

Management of Long QT Syndrome: A Systematic Review

“…These patients, exhibiting a higher risk for SCD due to arrhythmias such as atrioventricular block and sinus arrest, frequently benefit from ICDs as primary treatment, especially when β-blockers fail to prevent syncope or ventricular tachycardia. Guidelines suggest ICD placement as a class II indication for LQTS patients experiencing life-threatening arrhythmias despite β-blocker therapy, highlighting its importance in preventing sudden death among high-risk groups [ 24 ].…”