Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: Intermediate and long-term follow-up

Abstract

BACKGROUND Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown. OBJECTIVE The purpose of this study was to evaluate the intermediate and long-term effects of left and bilateral CSD in patients with cardiomyopathy and refractory VT or VT storm. METHODS Retrospective analysis of medical records for patients who underwent either left or bilateral CSD for VT storm or refractory VT between April 2009 and December 2012 was performed. RESULTS Forty-one patients underwent CSD (14 left CSD, 27 bilateral CSD). There was a significant reduction in the burden of implantable cardioverter-defibrillator (ICD) shocks during follow-up compared to the 12 months before the procedure. The number of ICD shocks was reduced from a mean of 19.6 ± 19 preprocedure to 2.3 ± 2.9 postprocedure (P < .001), with 90% of patients experiencing a reduction in ICD shocks. At mean follow-up of 367 ± 251 days postprocedure, survival free of ICD shock was 30% in the left CSD group and 48% in the bilateral CSD group. Shock-free survival was greater in the bilateral group than in the left CSD group (P = .04). CONCLUSION In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.

Inflammation, oxidative stress, and glial cell activation characterize stellate ganglia from humans with electrical storm

“…These findings support the use of denervation via partial resection of the stellate ganglion to control arrhythmias (5,34,35) and to mitigate the progression of dilated CMY (36). Pathological changes within stellate ganglia that act to enhance neurotransmission create further electrical instability (37), increasing the risk of arrhythmias.…”

Sympathetic modulation of electrical activation in normal and infarcted myocardium: implications for arrhythmogenesis

“…One implication of the present study is that unilateral (left-sided) sympathectomy may be inadequate for arrhythmia control if the VT originates from the anterior wall. This may account for certain failures of left sympathectomy for arrhythmia control and emphasizes the role of bilateral sympathetctomy over unilateral (55).…”

Effects of stepwise denervation of the stellate ganglion: Novel insights from an acute canine study

“…3 Cardiac sympathetic denervation (CSD) has been shown to reduce the burden of ventricular arrhythmias acutely. 4 Preganglionic sympathetic efferents arising from the T1-T4 spinal cord that project to the heart transit through stellate ganglia via the paravertebral chain. In left-sided CSD procedures, the lower half (T1-T4) of the left side of the SG (LSG) is removed.…”