Real world data on management and outcomes of ventricular tachycardia (VT) storm are scarce. This prospective study evaluates the clinical profile, in-hospital outcome and intermediate outcome in patients presenting with VT Storm. A majority (36/50, 72%) were male and the age was 54 ± 15 years. Scar VT was the most common underlying substrate for VT stormand pleomorphic VT was the predominant morphology. Twenty-one (42%) patients underwent cardiac sympathetic denervation, 6 (12%) patients underwent radiofrequency ablation (RFA), 3 (6%) patients amongst these underwent both the precedures in addition to conventional medical management. The overall mortality was 18% and VT free survival was 54%at 6 months follow up. VT recurrence was more common with severe LV dysfunction.

Iatrogenic arteriovenous fistula is a unique complication during pacemaker implantation. A 55‐year‐old man was posted for pacemaker implantation for recurrent unexplained syncope with trifascicular AV block. After axillary/subclavian venous puncture and introduction of RV lead, arterial spurting was immediately noticed as the the sheath was peeled away. After dissecting the overlying pectoralis muscle, deep sutures and manual compression achieved hemostasis. However, Subclavian arteriogram revealed an arteriovenous fistula from a lateral thoracic artery branch to the innominate vein. Hilal coils were deployed near the fistulous orifice, leading to complete resolution of the leak. After 3 days, pacemaker was implanted from right side. A multidisciplinary approach was the key to successful outcome.

Background Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long‐term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA. Methods We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT. Results A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow‐up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter‐defibrillator (ICD) or external defibrillator shocks post‐CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint. Conclusion The current retrospective analysis re‐emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.

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Background: Cardiac Sympathetic Denervation (CSD) involves surgical removal of lower half of the stellate ganglion and the T1-T4 ganglia for reducing sympathetic discharge to the heart. CSD is a useful therapeutic option in patients with ventricular tachycardia (VT) when they are non-responsive to standard drug therapy or catheter ablation. We report here the clinical profile and long-term outcome of all our patients who underwent CSD for refractory VT or VT storm. Method: Data of all patients who underwent CSD from 2010 to 2019 was analysed. They were regularly followed up, focusing on arrhythmia recurrence. Complete response to CSD was defined as more than 75% decrease in the frequency of VT. Results: A total of 65 patients (50 male, 15 female) underwent CSD in the above-mentioned period and the duration of follow-up was 27±24 months.The underlying substrate was for VT was coronary artery disease in 30 (46.2%) patients and 35 (53.8%) patients had a variety of other causes. Complete response to CSD was attained in 47 (72.3%) patients. There was a significant decline in the incidence of number shocks after CSD (24±37 vs 2±4; p <0.01). Freedom from a combined end point of ICD shock or death at the end of two years was 51.5%. Advanced NYHA class (III and IV) was the only parameter shown to have significant association with this combined end point. Conclusion: The current retrospective analysis reemphasize the role of surgical CSD in the treatment of patients with refractory VT or VT storm.