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Long-Term Outcomes of Ultrasound-Guided Percutaneous Bilateral Cardiac Sympathetic Denervation in Patients With
José M López González1, Daniel García Iglesias2, Bárbara M Jiménez Gómez1
1Department of Anesthesiology, Perioperative and Pain Medicine, Asturias University Central Hospital, Oviedo, Spain.
Objectives:
Increasing evidence suggests that stellate ganglion block (SGB) and bilateral cardiac sympathetic denervation (BCSD) produce a sustained cessation of refractory arrhythmic storms. This study aimed to evaluate the efficacy and safety of ultrasound-guided percutaneous SGB and BCSD in patients with refractory arrhythmic storm.
Design:
Prospective observational cohort study.
Setting:
Single-center tertiary hospital.
Participants:
All consecutive patients undergoing SGB and BCSD for refractory electrical storm (April 2023 to September 2024) were included.
Interventions:
For BCSD, 2 conventional radiofrequency lesions were created, followed by levobupivacaine infiltration.
Measurements And Main Results:
The primary outcome was the change in sustained ventricular arrhythmias over a period of 12 months. Eighteen patients were enrolled; fifteen completed follow-up. A significant reduction in sustained ventricular arrhythmias and implanted device shocks/ablations was observed within 24 hours after SGB, with temporary stabilization for nearly 12 months after BCSD (median [interquartile range], 4 [2-7.5] at baseline v 0 [0-0.5] at 3 months [p < 0.01] and 1.5 [0-3] at 12 months [p = 0.05]). The 12-month overall survival rate was 58%. Transient Horner syndrome occurred in 73% of patients; 1 patient had prolonged ptosis resolving within 2 weeks without sequelae. No hospitalizations for arrhythmic storm occurred during follow-up; 27% of patients underwent heart transplantation. The overall mortality rate was 33%, with all deaths attributable to cardiovascular disease progression.
Conclusions:
BCSD is safe and effective for controlling arrhythmic events in refractory arrhythmic storm, significantly reducing ventricular arrhythmias during the first 6 months after the procedure and providing temporary stabilization for nearly 12 months with few adverse effects. Furthermore, it is associated with a 58% 12-month overall survival rate.