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

Chronic intractable ventricular tachycardia can cause significant morbidity and mortality. In the setting of failed intracardiac ablation, interruption of the sympathetic nerve can provide relief. We present our series of thoracoscopic sympathectomy for chronic recurrent and intractable ventricular tachycardia.

We retrospectively reviewed records of sympathectomies performed at a large academic medical center between January 2018 and February 2024. We collected information regarding patients' procedures, cardiovascular history, hospital course, postoperative cardiovascular outcomes, and mortality.

A total of 20 patients underwent sympathectomy for refractory cardiac arrhythmias. Two patients died in the hospital for reasons unrelated to surgery. Three patients were lost to follow-up. Of the 15 remaining patients, 2 patients died after hospitalization due to recurrent arrythmias, 1 patient died due to unknown reasons, and 12 patients were living and had follow-up. Three of these patients were without further arrythmias. Four patients had notable reduction in their symptoms. Two patients had continued episodes of ventricular tachycardia, and 3 patients proceeded to listing for heart transplantation. After surgery, 7 patients were recorded as having further ablations, with a maximum of 2 postoperative ablations. The mean number of postoperative ablations was 0.4.

In a cohort of critically ill patients with refractory cardiac arrhythmias, sympathectomy is well tolerated. In this case series, a large proportion of patients undergoing sympathectomy experienced significant symptom reduction or complete remission of their cardiac pathologies, indicating that this procedure should be considered in select patients with refractory arrhythmias.