Bilateral thoracoscopic sympathectomy for cardiac denervation in pediatric population: Does Kuntz nerve cauterization have an impact on success?

Abstract

Introduction Cardiac sympathetic denervation (CSD) is an effective procedure for the treatment of inherited channelopathies. Left CSD has traditionally been recommended as neuromodulation to prevent arrhythmia episodes; however, it is thought that bilateral sympathectomy in combination with Kuntz ablation may have additional effects effective due to the anatomical variability of preganglionic sympathetic fibers. The aim of the study was to share our single‐center clinical experience with bilateral thoracoscopic sympathectomy for cardiac denervation in different groups of pediatric patients with malignant arrhythmias. Methods Fourteen patients (seven with CPVT, five with LQTS, one with resistant ventricular tachycardia as a sequela of myocarditis, and one with cardiomyopathy and atrial tachycardia) underwent bilateral thoracoscopic sympathectomy for cardiac denervation. Results In all patients, arrhythmia episodes persisted despite medical therapy, and patients with implantable cardioverter‐defibrillator received appropriate therapies. The rate of appropriate therapies was 3.25 per year (1–5 per year) in the year before sympathectomy. No major complications related to the procedure were observed in any of the patients. The QTc interval of LQTS patients decreased from 506.2 ± 16.9 ms before the procedure to 476 ± 28.8 ms after the procedure. The mean duration of follow‐up after the procedure was 23.3 months (11–47 months). Only two patients received single episodes of therapy 12 and 22 months after CSD, and one patient had arrhythmic events due to noncompliance to medical therapy. Conclusion Due to the anatomical variability of preganglionic fibers bilateral CSD with Kuntz nerve ablation effective treatment and is a safe option.

Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias

“…One study demonstrated a 70% success rate for BCSD in managing refractory VAs [ 10 ]. Multiple studies have suggested that BCSD may have a stronger antiarrhythmic effect than LCSD [ 2 , 11 ]. A case series documented a 90% complete resolution of ICD shocks following BCSD [ 12 ].…”

“…If patients are intolerant to these drugs or if VAs persist despite medication, catheter ablation and the insertion of implantable cardioverter defibrillators (ICD) may be considered. For arrhythmias that remain unmanageable with standard treatments, cardiac sympathetic denervation could serve as an additional therapeutic strategy [ 1 - 3 ].…”

Bilateral cardiac sympathetic denervation for refractory arrhythmia in an individual with catecholaminergic polymorphic ventricular tachycardia associated with T-cell-mediated ganglionitis

“…While RCSD alone remains an unconventional therapeutic option, bilateral cardiac sympathetic denervation has shown promise within small series in the treatment of refractory ventricular arrhythmia across a range of conditions including ischaemic and nonischaemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (ARVC) and Chagas disease,12–16 with a randomised trial planned 17. However, there is a paucity of evidence for outcomes in patients with CPVT.…”

A Case Report of Elective Bilateral Proximal Intercostal Blocks Used to Prevent Arrhythmia in Catecholaminergic Polymorphic Ventricular Tachycardia

“…2 Typically, a stellate ganglion block (SGB) is utilized, but this procedure remains technically challenging and can cause rare but dangerous side effects. 3 The proximal intercostal block has been suggested as an alternative technique that is conducive to continuous blockade via catheters while maintaining a favorable safety profile. 4 This report describes the elective, novel, effective, and safe use of bilateral continuous proximal intercostal blocks to provide therapeutic sympathetic blockade in CPVT.…”