Simplified left cardiac sympathetic denervation as an acute strategy for recurrent ventricular tachycardia in multimorbid patients with structural heart disease: A case series
Abstract
Background Cardiac sympathetic denervation as a treatment for drug-refractory ventricular arrhythmias (VAs) involves video-assisted thoracoscopic removal of the stellate ganglion (SG) and thoracic ganglia. A simplified approach sparing the SG and targeting left T2–T4 ganglia (left cardiac sympathetic denervation [LCSD]) may offer a less invasive alternative. Objective This study aimed to evaluate the efficacy and safety of simplified SG-sparing LCSD as a bailout procedure for multimorbid patients with structural heart disease and recurrent VAs refractory to antiarrhythmic drugs and/or catheter ablation. Methods All patients undergoing SG-sparing LCSD at our institution between June 2023 and June 2024 were included in this single-center retrospective study. Baseline demographics, procedural complications, and arrhythmia outcomes were analyzed. Results LCSD was performed in 7 patients (mean age 75.9 ± 6.7 years, mean LVEF 30.7 ± 10.9%) with structural heart disease (nonischemic cardiomyopathy, n = 3; ischemic cardiomyopathy, n = 4) mostly 1 day (interquartile range 1–21) after admission with a procedure duration of 20.7 ± 5.3 minutes. Initially, 4 patients (57.1%) had electrical storm. Apart from 1 pleural effusion requiring drainage, no major complications or Horner’s syndrome occurred. During a follow-up of 7 ± 2.6 months, median VA episodes requiring implantable cardioverter-defibrillator therapy decreased from 14 to 2 (P = .021) and median implantable…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 7 participants or records.
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