Key result
Bilateral thoracoscopic cardiac sympathetic denervation resulted in a reduction or cessation of arrhythmias and ICD shocks with no periprocedural complications in all three patients.
Why the study?
Publications on bilateral thoracoscopic cardiac sympathetic denervation remain scarce despite its potential as an underutilised last-resort modality for patients with refractory ventricular tachyarrhythmias and electrical storm.
Does bilateral thoracoscopic cardiac sympathetic denervation reduce arrhythmias and ICD shocks in patients with refractory ventricular tachyarrhythmias?
Case Report (n=3)
No
Does bilateral thoracoscopic cardiac sympathetic denervation reduce arrhythmias and ICD shocks in patients with refractory ventricular tachyarrhythmias?
Bilateral thoracoscopic cardiac sympathetic denervation is a safe and feasible last-resort technique that effectively reduces ICD shocks in patients with refractory ventricular tachyarrhythmias.
May warrant consideration as last-resort in refractory electrical storm; leaves open need for prospective validation.
OBJECTIVES: To explore the efficacy and safety of bilateral thoracoscopic cardiac sympathetic denervation (BTCSD) as an underutilised last‑resort surgical technique for patients with ventricular tachyarrhythmias and electrical storm non-responsive to other treatment. BACKGROUND: Patients with refractory ventricular tachycardia, ventricular fibrillation, and electrical storm are at high risk of sudden cardiac death. In some patients, suboptimal results are achieved despite treatment with anti-arrhythmic drugs, implantable cardioverter-defibrillator and cardiac catheter ablation. Minimally invasive surgery affecting the stellate ganglions and sympathetic chain is an additional alternative treatment modality that may help avoid heart transplantation. METHODS: We present our experience of 3 patients who were treated with this technique for the first time in Slovakia in cooperation with the National Institute for Cardiovascular Diseases. Publications on this issue are scarce despite its potential for specific patients. Modifications to avoid complications derived from our experience of sympathectomies for hyperhidrosis are introduced, and improvements are proposed to promote this technique. RESULTS: All patients showed a reduction or cessation of arrhythmias and ICD shocks with no periprocedural complications. CONCLUSION: Our experience showed that BTCSD is a safe and feasible technique with a low complication rate and promising results. The limitation of this paper is the low number of patients in our group (Tab. 1, Fig. 3, Ref. 25).
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Juhos et al. (2022) conducted a case report in Refractory ventricular tachyarrhythmias (n=3). Bilateral thoracoscopic cardiac sympathetic denervation was evaluated on Reduction or cessation of arrhythmias and ICD shocks. Bilateral thoracoscopic cardiac sympathetic denervation resulted in a reduction or cessation of arrhythmias and ICD shocks with no periprocedural complications in all three patients.
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