Left Sided Cardiac Sympathetic Denervation as a Successful Bail-Out Procedure in Ischemic and Non-Ischemic Cardiomyopathy Patients with Incessant Ventricular Tachycardia: A Case Series

Introduction: 

Cardiac sympathetic denervation (CSD) may be an effective treatment for selected patients with drug-refractory ventricular arrhythmias (VA). We report the results of our single-center experience with video-assisted thoracoscopic removal of the left stellate ganglia (LCSD) in patients with ischemic (ICM) and non-ischemic cardiomyopathies (NICM) and VA despite antiarrhythmic drug (AAD) therapy and/or prior ventricular tachycardia (VT) ablation. 

Methods: 

We performed a retrospective clinical review of all patients who underwent LCSD by video-assisted thoracoscopic surgery at our institution from June 2023 to June 2024. Baseline demographic, medical, and surgical data, procedural complications, and arrhythmia outcomes were evaluated. 

Results: 

Six patients (mean age 76.2 ± 7.3 years, mean LVEF 28.7 ± 10.4 %) with NICM (n = 2) and ICM (n = 4) underwent LCSD for refractory VA despite multiple AADs (mean number of AADs was 1.7 ± 0.5) and prior VT ablation (mean number of procedures per patient was 0.5 ± 0.5). The mean procedure time was 22.5 ± 5.8 minutes. There were no major procedure-related complications except for one left pleural effusion requiring drainage 4 weeks after the procedure. During follow-up (mean 4 ± 1.8 months), the median number of VAs with adequate ICD therapy decreased from 15 to 0.5 episodes (p = 0.027) and the median number of ICD shocks decreased from 1.5 to 0 episodes (p = 0.068) compared to the 90 days before LCSD. Two patients remained free of sustained VA recurrences. One patient died of COVID infection without VA recurrence. 

Conclusions: 

In our analysis, LCSD was effective in treating VAs in patients with NICM and ICM who were refractory to AADs and VT ablation or ineligible for VT ablation. This simplified left-sided approach showed good results in achieving freedom from VAs with a low complication rate. Further studies are warranted to confirm these findings and to elucidate the long-term outcomes of this approach.