Surgical Cardiac Sympathetic Denervation for Ventricular Arrhythmias: A Systematic Review^CME

Abstract

Ventricular arrhythmias are potentially life-threatening disorders that are commonly treated with medications, catheter ablation and implantable cardioverter defibrillator (ICD). Adult patients who continue to be symptomatic, with frequent ventricular arrhythmia cardiac events or defibrillation from ICD despite medical treatment, are a challenging subgroup to manage. Surgical cardiac sympathetic denervation has emerged as a possible treatment option for people refractory to less invasive medical options. Recent treatment guidelines have recommended cardiac sympathectomy for ventricular tachycardia (VT) or VT/fibrillation storm refractory to antiarrhythmic medications, long QT syndrome, and catecholaminergic polymorphic VT, with much of the data pertaining to pediatric literature. However, for the adult population, the disease indications, complications, and risks of cardiac sympathectomy are less understood, as are the most effective surgical cardiac denervation techniques for this patient demographic. This systematic review navigates available literature evaluating surgical denervation disease state indications, techniques, and sympathectomy risks for medically refractory ventricular arrhythmia in the adult patient population.

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

“…[ 17 ] Other studies have reported effectiveness ranging from 70% to 80% within the first month to the first year after VAT-CSD. [ 18 – 22 ]…”

“…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. Significant reductions in the number of ICD shocks in the month after surgery compared with before surgery, as well as a decrease in ED visits after VAT-CSD, were observed.…”

Successful management of near-incessant bidirectional ventricular tachycardia in one-year-old child with COVID-19 infection: a case report

“…Left partial thoracic sympathectomy can be a helpful option in patients with sustained ventricular tachycardia and multiple ICD shocks, in whom antiarrhythmic treatment or VT ablation is useless or not available. 10 …”

Bilateral thoracoscopic cardiac sympathetic denervation in patients with refractory ventricular tachyarrhythmias non‑responsive to other treatment

“…Some of them, including compensatory hyperhidrosis, cannot be effectively avoided due to the nature of the intervention and its targeted organ. Compensatory sweating on a different part of the body like the chest, back, or abdomen results as a consequence of sympathectomy based on negative afferent feedback (17). Its degree varies from mild through moderate to intense and could be perceived differently by individual patients.…”