Why the study?
Does bilateral cardiac sympathectomy prevent ventricular tachycardia and ICD discharges in a patient with nonischemic cardiomyopathy refractory to standard therapies?
Does bilateral cardiac sympathectomy prevent ventricular tachycardia and ICD discharges in a patient with nonischemic cardiomyopathy refractory to standard therapies?
Bilateral cardiac sympathectomy may be an effective treatment option for life-threatening ventricular tachycardia that is refractory to antiarrhythmic drugs and ablation.
May support sympathectomy for refractory nonischemic VT; hypothesis-generating and requires prospective confirmation before practice change.
Ventricular tachycardia (VT) commonly occurs in patients with ischemic or nonischemic cardiomyopathy and requires antiarrhythmic drugs, ablation, or advanced circulatory support. However, life-threatening VT may be refractory to these therapies, and may cause frequent implantable cardioverter defibrillator (ICD) discharges. Left cardiac sympathetic denervation reduces the occurrence of these fatal arrhythmias by inhibiting the sympathetic outflow to the cardiac tissue. We present a 69-year-old man with nonischemic cardiomyopathy, life-threatening VT, and hemodynamic instability with numerous ICD discharges, who remained refractory to antiarrhythmic drug therapy and ablation attempts. He was effectively treated with bilateral cardiac sympathectomy. Six months later, he remained free of VT with no ICD discharges.
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Kopecky et al. (2017) studied this question.
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