Surgical therapy in patients with arrhythmias: cardiac sympathetic denervation

BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) and long QT syndrome (LQTS) are genetic channelopathies that are characterized by life-threatening ventricular arrhythmias triggered by increased sympathetic activity. Treatment options include pharmacotherapy, implantable cardioverter-defibrillators (ICDs) and cardiac sympathetic denervation. Cardiac sympathetic denervation, a surgical procedure, is a treatment option for patients with life-threatening arrhythmias despite medical therapy. In this study, we present our video-assisted thoracoscopic cardiac sympathetic denervation experience in our institution.METHODS: Included in our study were six patients who underwent video-assisted thoracoscopic cardiac sympathetic denervation due to recurrent ventricular fibrillation (VF) storm despite medical therapy in our clinic between 2008 and 2021, who were analyzed retrospectively.RESULTS: The sample included four females and two males aged 18-39 years, among whom four cases had long QT syndrome, one had catecholaminergic polymorphic ventricular tachycardia and one case had long QT syndrome/Brugada syndrome. All patients underwent a video-assisted thoracoscopic left cardiac sympathetic denervation (LCSD) procedure. Complete remission was achieved in all four patients with isolated long QT syndrome. The patient followed up for catecholaminergic polymorphic ventricular tachycardia underwent a right cardiac sympathetic denervation (RCTD) three months later due to persistent shocks. The last patient died within six weeks due to resistant monomorphic VT.CONCLUSIONS: Video-assisted thoracoscopic cardiac sympathetic denervation can be considered a safe and effective treatment for recurrent VF attacks, despite the maximum tolerated dose of beta-blockers, especially in patients with long QT syndrome.