Left sympathetic cardiac denervation in managing electrical storm: acute outcome and long term follow up
Mukund A Prabhu1, Srinivas B V Prasad1, S P Abhilash1
1Department of Cardiology, Sree Chitra Tirunal institute of Medical sciences and Technology, Medical college [PO], Trivandrum, 695011, Kerala, India.
Insights
Left sympathetic cardiac denervation (LSCD) effectively controls electrical storm (ES) and reduces ventricular arrhythmias (VA) long-term. Pharmacological LSCD is a valuable bedside option when advanced procedures are unavailable.
Area of Science:
- Cardiology
- Electrophysiology
- Thoracic Surgery
Background:
- Electrical storm (ES) poses a significant threat, often requiring advanced interventions.
- Left sympathetic cardiac denervation (LSCD) is explored as a therapeutic option for refractory ES.
Purpose of the Study:
- To analyze the outcomes and long-term follow-up of patients undergoing LSCD for electrical storm.
- To evaluate the efficacy of LSCD in reducing ventricular arrhythmias (VA) and improving patient survival.
Main Methods:
- Retrospective analysis of nine patients with ES who underwent LSCD.
- Procedures included percutaneous stellate ganglion blockade and video-assisted thoracoscopic sympathectomy (VATS).
Main Results:
- LSCD achieved a >90% reduction in VA in 55% and >80% in 77.78% of patients.
- One patient died from ES, and one experienced sudden death post-procedure.
- Long-term follow-up showed sustained VA reduction in most survivors, with one death from heart failure and one ES recurrence.
Conclusions:
- LSCD is an effective treatment for controlling ES and reducing long-term VA burden.
- Pharmacological LSCD offers a bedside alternative, particularly in centers lacking advanced interventional capabilities.
Purpose:
Left sympathetic cardiac denervation (LSCD) may be beneficial in treating electrical storm (ES) of varied aetiologies. The present study analyse the outcome and long term follow up of LSCD in treating ES.
Methods:
This is a retrospective study of patients with ES who underwent LSCD.
Results:
Nine patients (majority males (88.89 %), median age 52 years, IQR 50.5-56.5) underwent LSCD. Coronary artery disease was the commonest substrate (7 (77.78 %)). Five patients, who had hypotension and unstable hemodynamics, underwent percutaneous stellate ganglion blockade. Three of the survivors subsequently underwent surgical sympathectomy. In the remaining four, video assisted thoracoscopy (VATS) guided sympathectomy was performed. Five (55 %) and seven (77.78 %) had a >90 and 80 % reduction in ventricular arrhythmias (VA), respectively. LSCD was ineffective in one patient, who succumbed to ES. There was no difference in outcome between patients with monomorphic versus polymorphic VA (60 vs 70 %, respectively, p = 0.82). One (11.1 %) patient had sudden death on the fifth day after LSCD. The median hospital stay was 13 days (IQR 11-16). During median 34 months of (IQR 18-46) follow up, one patient died of heart failure, and another had recurrence of ES. There was sustained reduction in VA burden in others.
Conclusion:
LSCD is effective in controlling ES and continues to reduce the incidence of VAs during long term follow up. Pharmacological LSCD needs particular emphasis, as it can be performed at bedside, and can be a bail-out procedure in centres where sophisticated procedures like VATS-guided LSCD or radiofrequency ablation are not readily available.
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