Abstract 9618: Bilateral Cardiac Sympathetic Denervation for Acute Management of Refractory Ventricular Arrhythmias
Background: Left cardiac sympathetic denervation (LCSD) suppresses ventricular arrhythmias (VAs), and reduces the incidence of sudden cardiac death (SCD). The role of bilateral cardiac sympathetic denervation (BCSD) remains unknown. The purpose of this study was to report the effects of BCSD in a small patient cohort.
Methods: We reviewed records of 6 patients (5 males, age 47-75 years, 66.7% non-ischemic cardiomyopathy) who underwent BCSD to treat severe VAs refractory to all other treatment modalities. Reversible causes of VAs were addressed in all patients. All patients were on beta-blocker therapy, and at least one antiarrhythmic drug. Five patients underwent catheter mapping with endocardial and/or epicardial ablation to control VAs (mean 2.2±0.5 ablations/patient). VAs persisted in 3 patients despite prior LCSD. Surgical BCSD was successfully performed in all patients (50% simultaneously, 50% right cardiac sympathetic denervation after prior unsuccessful LCSD).
Results: After BCSD, mean ICD shocks and anti-tachycardia pacing episodes (ATPs) decreased from 13.3±5.2 shocks and 26.8±12.6 ATPs to 0 shocks or ATPs in 3 patients, and decreased by over 50% in one patient. External shocks decreased from 11 to 0 in another patient. One patient showed no response to BCSD. All patients who responded to BCSD survived to hospital discharge. No major complications occurred in all patients. In three patients were not pacemaker-dependent, no significant changes in heart rate, PR, QRS, and corrected QT interval were noted.
Conclusion: To our knowledge, this is the first reported cohort of patients to undergo BCSD. In these patients with electrical storm refractory to standard therapies, bilateral cardiac sympathetic denervation was safe and effective in acutely suppressing VAs, and preventing SCD.
- © 2011 by American Heart Association, Inc.