The Treatment of Recurrent Ventricular Tachycardia with Bilateral Cervico-Thoracic Sympathetic-Ganglionectomy

Abstract

Two patients had bilateral cervico-thoracic sympatho-ganglionectomy for treatment of disabling symptoms due to refractory ventricular tachycardia. In both patients treatment with antiarrhythmic drugs singly, in combination, or together with pacemaker overdrive had been ineffective in controlling this arrhythmia.Both patients had normal coronary arteriograms.Bilateral thoracic svmpathectomv appears to facilitate medical management of ventricular tachycardia in selectecl patients wx ho are refractorv to the usual medical treatment. Additional Indexing Words:Refractorv ventricular tachvcardia Thoracic svmpathectomv RECURRENT VENTRICULAR TACHYCARDIA not associated with coronary disease is uncommon. There have been sporadic reports of ventricular tachycardia without other evidence of heart disease, and Lesch et al. collected 34 reports of such patients between ages 2 and 40.1 This report relates our recent experience with two patients who had normal coronary arteriograms and who had recurrent incapacitating ventricular tachycardia, which proved refractory to conventional measures. NMedical management of their arrhythmias was facilitated by bilateral cervico-thoracic sympathetic ganglionectomy. Prior experience with sympathectomy in this situation is reviewed. Case ReportsCase 1 Patient M.E., a 48-year-old Caucasian housewife, was first admitted to the Arizona Medical Center on July 24, 1973.The patient was in good health until one week prior to ad-Fromn the Sections of Cardiology and Cardiovascular Surgery,

Thoracic Epidural Anesthesia Can Be Effective for the Short‐Term Management of Ventricular Tachycardia Storm

“…Bilateral thoracic sympathectomy was first described by Estes and Izlar 4 in 1961 to successfully treat a 35‐year‐old man with incessant runs of VT, refractory to medical therapy. Since then, CSD by surgical left or bilateral stellate ganglionectomy has been used successfully to manage recurrent ventricular arrhythmias in patients with long QT syndrome, catecholaminergic polymorphic VT, idiopathic VT, and VT associated with structural heart disease …”

Effects of Bilateral Stellate Ganglion Block on Autonomic Cardiovascular Regulation

“…25,26 One report has also described the use of bilateral cervico-thoracic sympathetic ganglionectomy to treat disabling symptoms due to refractory ventricular tachycardia. 27 However, the effects of SGB on cardiovascular regulation remain controversial. 10,12,13,28 Our results do not reveal the exact mechanisms underlying changes in cardiovascular and autonomic regulation; however, we presume that these alterations might be due, at least in part, to blockade of arterial and cardiopulmonary baroreceptors by local anesthetic agents.…”

Variations in presentation and various options in management of variant angina

“…Recently, unilateral and/or bilateral cervicothoracic sympathetic ganglionectomy for recurrent ventricular tachycardia and prolonged QT interval was reported with good results [211,212].…”