Limited Left Thoracoscopic Sympathectomy Effectively Silences Refractory Electrical Storm

Area of Science:

• Cardiology
• Thoracic Surgery
• Electrophysiology

Background:

• Electrical storm (ES) is a critical condition affecting up to 20% of patients with implantable cardioverter defibrillators.
• Refractory ES in low-ejection fraction patients poses a significant treatment challenge, especially when catheter ablation is not an option.

Purpose of the Study:

• To evaluate the efficacy of left video-assisted thoracoscopic sympathectomy/ganglionectomy (VATSG) for treating electrical storm (ES).
• To assess VATSG as an initial treatment in patients with low ejection fraction who are not candidates for catheter ablation.

Main Methods:

• Retrospective analysis of 12 patients with ES undergoing 14 left VATSG procedures.
• Data collected included demographics, survival, cardioversion frequency (pre- and post-VATSG), readmissions, and need for further procedures.

Main Results:

• Mean shocks decreased from 22.67 in 30 days pre-VATSG to 3.55 post-surgery for survivors.
• Median follow-up of 358 days showed a median of zero shocks post-VATSG.
• Six patients had no further cardioversions, and 5 were not readmitted for ventricular tachycardia.

Conclusions:

• Left VATSG is an effective initial treatment for ES in patients ineligible for catheter ablation.
• The procedure is suitable even for patients requiring venoarterial extracorporeal membrane oxygenation for hemodynamic support.