Thoracoscopic Sympathectomy for Chronic Recurrent and Intractable Ventricular Tachycardia: A Case Series

Area of Science:

• Cardiology
• Thoracic Surgery
• Autonomic Nervous System

Background:

• Chronic intractable ventricular tachycardia leads to significant morbidity and mortality.
• Intracardiac ablation may fail to provide relief for refractory arrhythmias.
• Sympathetic nerve interruption via thoracoscopic sympathectomy is an alternative treatment option.

Purpose of the Study:

• To present a series of thoracoscopic sympathectomy procedures for chronic, recurrent, and intractable ventricular tachycardia.
• To evaluate the safety and efficacy of sympathectomy in patients with refractory cardiac arrhythmias.

Main Methods:

• Retrospective review of sympathectomy records from January 2018 to February 2024 at a large academic medical center.
• Collected data included patient procedures, cardiovascular history, hospital course, postoperative outcomes, and mortality.
• Analysis of 20 patients who underwent sympathectomy for refractory cardiac arrhythmias.

Main Results:

• Twenty patients underwent thoracoscopic sympathectomy for refractory cardiac arrhythmias.
• Postoperative outcomes varied, with some patients experiencing symptom reduction or remission, while others required further treatment or transplantation.
• The procedure was generally well-tolerated, with a low rate of surgery-related mortality.

Conclusions:

• Thoracoscopic sympathectomy is a well-tolerated procedure in critically ill patients with refractory cardiac arrhythmias.
• A significant proportion of patients experienced symptom reduction or complete remission, suggesting its consideration in select cases.
• Sympathectomy should be considered as a therapeutic option for patients with refractory arrhythmias unresponsive to other treatments.