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Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate

Marmar Vaseghi1, Jean Gima1, Christopher Kanaan1

  • 1UCLA Cardiac Arrhythmia Center, Los Angeles, California.

Heart Rhythm
|December 3, 2013
PubMed

Insights

Bilateral cardiac sympathetic denervation (CSD) significantly reduces implantable cardioverter-defibrillator shocks in ventricular tachycardia storm patients long-term. Bilateral CSD offers greater shock-free survival than left CSD.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Surgical Procedures

Background:

  • Cardiac sympathetic denervation (CSD) offers acute ventricular arrhythmia burden reduction.
  • Long-term efficacy of CSD for ventricular tachyarrhythmia (VT) storm remains largely unknown.

Purpose of the Study:

  • To assess intermediate and long-term outcomes of left and bilateral CSD.
  • Evaluate CSD effectiveness in patients with cardiomyopathy and refractory VT or VT storm.

Main Methods:

  • Retrospective analysis of medical records.
  • Included patients undergoing left or bilateral CSD for VT storm or refractory VT (April 2009-December 2012).

Main Results:

  • Forty-one patients underwent CSD (14 left, 27 bilateral).
  • Significant reduction in implantable cardioverter-defibrillator (ICD) shocks post-procedure (19.6 to 2.3, P < .001).
  • 90% of patients had reduced ICD shocks; 48% bilateral CSD patients were shock-free at mean 367-day follow-up, versus 30% for left CSD (P = .04).

Conclusions:

  • Bilateral CSD is more effective than left CSD for VT storm.
  • CSD's benefits extend beyond the acute phase, providing sustained ICD shock reduction.
Abstract

Keywords:
Cardiac denervationElectrical stormSympathectomyVentricular arrhythmias

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