Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: a single-center series

Abstract

BackgroundThe combined treatment of beta-blockers with ablation and Implanted cardioverter defibrillation therapy, continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients.Case series presentationDuring a period of three years, from 2015 through 2017, twenty patients (N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (beta-blockers), Implanted Cardioverter defibrillation (ICD) and ablation therapy. All twenty patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. During the month prior to bilateral VATS denervation a combined total of twenty-nine (N = 29) ICD shocks were registered in addition to six (N = 6) cases of electrical storms averaging three (N = 3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N = 18/20) total resolution of ICD registered shocks, a 100% (N = 6/6) resolution of electrical storms, and a 92% (N = 11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities.ConclusionsBilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with life-threatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.

Role of cardiac sympathetic denervation in ventricular tachycardia: A meta‐analysis

“…We included 14 nonrandomized studies in our final analysis. 5,[11][12][13][14][15][16][17][18][19][20][21][22][23] Table 2.…”

“…Prisma flow diagram for the study selection is shown in Figure 1. We included 14 nonrandomized studies in our final analysis 5,11‐23 . Majority of the studies were from North America.…”

Surgical Approach in Congenital Long QT Interval Syndrome Patients

“…pleurae is redistributed 4. And last: Stellate ganglion, along with first 4 -5 thoracic ganglions are separated and detached (6) Procedure can also be performed by video-assisted thoracoscopy (VATS), reffering to a minimally invasive approach (23,24).…”

Anesthetic management in bilateral video-assisted thoracoscopic sympathectomy for refractory ventricular arrhythmias

“…The video-assisted thoracoscopic sympathectomy (VATS) was first described in 2000 and nowadays has become a therapeutic option for refractory ventricular arrhythmias (VA), with recent reviews showing a 70-80% effectiveness within the first year following the surgery. [ 1 ]…”