Abstract 2843: Neuraxial Modulation for Refractory Ventricular Arrhythmias in Humans: Value of Thoracic Epidural Anesthesia and Left Cardiac Sympathetic Denervation
Introduction: The autonomic nervous system plays a major role in the genesis and maintenance of ventricular arrhythmias. Reducing sympathetic output from the neuraxis can protect against arrhythmias.
Objective: To assess the value of thoracic epidural anesthesia (TEA) and left cardiac sympathetic denervation (LCSD) in the management of ventricular arrhythmias.
Methods: We reviewed clinical data from 10 patients (age 25–75 years, 53±18.5 yrs, 9 males) who underwent either TEA or LCSD to control ventricular arrhythmias refractory to the use of beta blockade, antiarrhythmicic drugs, and catheter ablation.
Results: Nine patients were in VT storm and one patient had recurrent VT on maximal therapy after a third partially successful VT ablation. Of the 9 patients in VT storm 8 had ICDs. Number of therapies ranged from 6 to 110, 45±34. Four patients underwent TEA, and 6 patients had LCSD. No procedural complications occurred. Post procedure 4 patients had complete arrhythmia resolution, 4 patients had partial arrhythmia resolution and 2 patients had an unsuccessful procedure(table⇓). Pt number 10 presented with incessant VT-had complete arrhythmia resolution for 72 hours post LCSD but then had a recurrence of VT storm and subsequently died. Of the ten patients, seven patients survived to hospital discharge, 2 patients had emergency heart transplantation, 4 were arrhythmia free, and 1 patient continued to experience intermittent VT.
Conclusion: TEA and LCSD had a positive impact on arrhythmia burden in 8/10 patients. Both procedures were well tolerated. TEA and LCSD could be an effective means of controlling refractory ventricular arrhythmias of varying etiologies.