Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation

Abstract

Background Recurrent ventricular tachycardia (VT) can occur after left ventricular assist device (LVAD) implantation. In this case, medical treatment might be insufficient. We report a case of a left‐sided thoracoscopic sympathectomy as a feasible treatment escalation in intractable VT. Case Report A 72‐year‐old patient underwent an internal cardioverter defibrillator (ICD) implantation as primary prophylaxis for VTs in the setting of staged heart failure therapy. Afterwards, due to a progressive dilative cardiomyopathy he underwent a minimal‐invasive LVAD implantation (HeartWare, Medtronic). After an uneventful minimal‐invasive LVAD‐implantation the patient was discharged to a rehabilitation program. However, after 7 weeks he developed recurrent VTs which were successfully terminated by ICD shocks deliveries leading to severe discomfort and frequent hospitalizations. Eventually, the patient was admitted with an electrical VT storm. Successful endocardial catheter ablation of all inducible VTs were performed combined with multiple rearrangements of his oral antiarrhythmic medication. However, all these treatments could not suppress further occurrence of VTs. After an interdisciplinary discussion the patient agreed to a left‐sided video‐assisted thoracoscopic sympathectomy. After a follow up of 150 days the patient was free from VTs apart from one short event. Conclusion We believe video‐assisted thoracoscopic sympathectomy might be a surgical treatment option in patients with intractable recurrent VTs after catheter ablation of VT reentrant substrate even after minimal‐invasive LVAD implantation.

Management of incessant ventricular arrhythmias in a patient with left ventricular assist device: a case report

“…The justification and use of stellate ganglion ablation typically emerge in cases where conventional treatment methods, such as antiarrhythmic drugs and catheter ablation, have either been ineffective or are considered inappropriate. A representative example [ 21 ] is a 72-year-old patient with an LVAD implant, who experienced persistent VAs resistant to both antiarrhythmic medication and catheter ablation. To address this, a video-assisted thoracoscopic sympathectomy was undertaken, providing significant symptomatic relief for a period of 150 days thereafter.…”

Catheter Ablation for Tachyarrhythmias in Left Ventricular Assist Device Recipients: Clinical Significance and Technical Tips

“…In addition, surgeons play a pivotal role in the management of refractory arrhythmias following LVAD implantation. Video-assisted thoracoscopic sympathectomy might be an option for suppressing recurrent VT refractory to catheter ablation [69].…”

Bilateral thoracoscopic cardiac sympathetic denervation in patients with refractory ventricular tachyarrhythmias non‑responsive to other treatment

“…Patients who are unresponsive or not compliant with this treatment regime and patients with electrical storms are candidates for thoracoscopic cardiac sympathetic denervation (3,4). Since these patients have a higher risk of sudden cardiac death, CSD provides an effective and safe dernier ressort method (5,6). At our Department of Thoracic Surgery in Bratislava, we perform this technique after the indication is made in cooperation with the Department of Arrhythmias and Pacing of the National Institute for Cardiovascular Diseases in Slovakia.…”