3 years ago

Cardiac Sympathectomy for the Management of Ventricular Arrhythmias Refractory to Catheter Ablation

Catheter ablation is now a mainstay of therapy for ventricular arrhythmias (VA). However, there are scenarios where either physiologic or anatomical factors make ablation less likely to be successful. Objectives To demonstrate that cardiac sympathetic denervation (CSD) may be an alternate therapy for patients with difficult to ablate VA. Methods We identified all patients referred for CSD at a single center for indications other than LQTS and CPVT who had failed catheter ablation. Medical records were reviewed for medical history, procedure details, and follow up. Results Seven cases of CSD were identified in patients who had failed prior catheter ablation or had disease not amenable to ablation. All patients had VA refractory to antiarrhythmic drugs (AAD) with a median arrhythmia burden of one episode sustained VA per month. There were no acute complications of sympathectomy. One of seven patients (14%) underwent heart transplant. No patient had sustained VA following sympathectomy at a median follow up of 7 months. Conclusion Due to anatomical and physiologic constraints, many VAs remain refractory to catheter ablation and remain a significant challenge for the electrophysiologist. While CSD has been described as a treatment for LQTS and CPVT, data regarding its use in other cardiac conditions is sparse. This series illustrates that CSD may be a viable treatment option in patients with a variety of etiologies of ventricular arrhythmias.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117310858

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