Abstract 17450: Left Cardiac Sympathetic Denervation for Patients With Malignant Ventricular Tachycardia in Chagas Disease - Preliminary Results of DESERT Study
Appropriated therapy (ICD-Shok) is an independet predictor of poor prognostic in pacient with Chronic Chagas Disease (CCD) and ICD. Imbalance in autonomic nerve system has been linked to the trigger of VT in Chagasic patients. Cardiac Sympathetic Blockade through surgical denervation of left chain (LCSD) has been shown to be useful in patients with long QT syndrome, but has not been tested in patients with VT and CCD.
DESERT is a prospective randomized study for patients with drug-refractory ICD-Shock due to malignant VT/VF.
Methods: Patients with Chagas Disease and at least 2 appropriated ICD shocks during the last month on amiodarone (at least 400 mg/day), beta-blockers, and ACE therapy were allocated to undergo LCSD. All patients underwent echocardiography, Holter monitoring, ECG and myocardial scintigraphy with I23I-mIBG before and after procedure. LCSD were performed either by intervention on the first thoracic ganglion (stellate) BEYOND the second, third and fourth thoracic ganglia or ON the second, third and fourth thoracic ganglia. Patients were followed-up at 30-days interval, and per protocol, no change in the ICD program or medication was allowed. The protocol was approved by local ethic committee.
Results: In this preliminary data we report the results of the first 5 patients with at least 6 months of follow-up (57y-o, 4 men, NYHA=2.2, LVEF=0.31). The mean appropriated therapy before LCSD was 28.6 (6.6 shocks and 23 ATP). After LCSD the mean appropriated therapy was 1.8 (p<0.001) in 2 patients. Three patients showed no ICD therapy. One patient had 2 ATP only in the first month after procedure. Importantly, no ICD shocks were noted during follow-up. There was no complication. Also, there was a significant reduction in total ventricular arrhythmias (VT/VF/PVC/h) before versus after LCSD (p<0.001).
Conclusion: In this preliminary study, Video-assisted LCSD showed to be a promising therapy for drug-refractory ventricular arrhythmias in Chagas disease.
- Alpha-adrenergic receptor blockers
- Arrhythmias, treatment of
- Implantable cardioconvert defibrillator
- Sudden death
- © 2013 by American Heart Association, Inc.