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Heart Rhythm. 2019 Jul;16(7):1003-1010. doi: 10.1016/j.hrthm.2019.01.019. Epub 2019 Jan 21.

Cardiac sympathectomy for refractory ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy.

Author information

1
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: fassis1@jhmi.edu.
2
Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
3
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
4
Division of Cardiac Surgery, PennState Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Abstract

BACKGROUND:

The sympathetic nervous system plays an important role in arrhythmogenesis in arrhythmogenic right ventricular cardiomyopathy (ARVC). Sudden cardiac death commonly occurs during exertion, and β-blockers are associated with a reduction in arrhythmia burden. Bilateral cardiac sympathetic denervation (BCSD) has been shown to reduce implantable cardioverter-defibrillator (ICD) shocks in patients with structural heart disease and refractory ventricular tachycardia (VT); however, data in ARVC are sparse.

OBJECTIVE:

The purpose of this study was to evaluate the role of BCSD in patients with ARVC and refractory VT.

METHODS:

Consecutive patients with ARVC who underwent BCSD because of refractory VT were included. Number of ICD shocks, sustained VT episodes, VT storm, and antiarrhythmic therapy were assessed and compared before and after the intervention. VT-free survival rate, death, and heart transplantation were also evaluated.

RESULTS:

Eight patients with ARVC (mean age 32 ± 20 years; 3 men [38%]) underwent sympathectomy for recurrent VT. All patients failed catheter ablation, and 50% had a desmosomal mutation identified. Procedural complications included neuropathic pain, paravertebral venous plexus injury, and pneumothorax. Over a mean follow-up of 1.9 ± 0.9 years, 5 patients (63%) had no VT recurrence. BCSD significantly reduced the number of ICD shocks or sustained VT compared with 1-year pre-BCSD (mean 12.6 ± 18.2 and median 6.5 [interquartile range 4.5-10.5] pre-BCSD vs 0.9 ± 1.4 and 0 [interquartile range 0-1.5] post-BCSD; P = .011). Most of the patients (88%) were on β-blocker therapy alone at the end of follow-up. One patient underwent heart transplantation because of heart failure, and no deaths occurred.

CONCLUSION:

BCSD may be an effective option for patients with ARVC and refractory ventricular arrhythmia who have failed conventional treatment modalities.

KEYWORDS:

Arrhythmogenic right ventricular dysplasia/cardiomyopathy; Cardiac sympathetic denervation; ICD shocks; Refractory ventricular tachycardia; Sympathectomy; Ventricular tachycardia recurrence

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