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Heart Rhythm. 2014 Mar;11(3):360-6. doi: 10.1016/j.hrthm.2013.11.028. Epub 2013 Nov 28.

Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up.

Author information

1
UCLA Cardiac Arrhythmia Center, Los Angeles, California. Electronic address: mvaseghi@mednet.ucla.edu.
2
UCLA Cardiac Arrhythmia Center, Los Angeles, California.
3
UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiothoracic Surgery, Los Angeles, California.
4
UCLA Cardiac Arrhythmia Center, Los Angeles, California; Department of Anesthesiology, UCLA Health System, Los Angeles, California.

Abstract

BACKGROUND:

Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown.

OBJECTIVE:

The purpose of this study was to evaluate the intermediate and long-term effects of left and bilateral CSD in patients with cardiomyopathy and refractory VT or VT storm.

METHODS:

Retrospective analysis of medical records for patients who underwent either left or bilateral CSD for VT storm or refractory VT between April 2009 and December 2012 was performed.

RESULTS:

Forty-one patients underwent CSD (14 left CSD, 27 bilateral CSD). There was a significant reduction in the burden of implantable cardioverter-defibrillator (ICD) shocks during follow-up compared to the 12 months before the procedure. The number of ICD shocks was reduced from a mean of 19.6 ± 19 preprocedure to 2.3 ± 2.9 postprocedure (P < .001), with 90% of patients experiencing a reduction in ICD shocks. At mean follow-up of 367 ± 251 days postprocedure, survival free of ICD shock was 30% in the left CSD group and 48% in the bilateral CSD group. Shock-free survival was greater in the bilateral group than in the left CSD group (P = .04).

CONCLUSION:

In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.

KEYWORDS:

Cardiac denervation; Electrical storm; Sympathectomy; Ventricular arrhythmias

PMID:
24291775
PMCID:
PMC4253031
DOI:
10.1016/j.hrthm.2013.11.028
[Indexed for MEDLINE]
Free PMC Article
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