Key result
Surgical cardiac sympathetic denervation was successful in 81.5% of patients with VT storm and significantly reduced the incidence of ICD or external shocks (25.2 vs 1.09).
Why the study?
CSD is typically used as a last resort for ventricular tachycardia, and data were needed on clinical profiles and long-term follow-up when performed predominantly upfront prior to catheter ablation for VT storm.
Does surgical cardiac sympathetic denervation reduce VT frequency and shocks in patients with VT storm?
Cohort (n=65)
Does surgical cardiac sympathetic denervation reduce VT frequency and shocks in patients with VT storm?
Surgical cardiac sympathetic denervation is highly effective (81.5% success) in reducing VT burden and shocks in patients with VT storm, even when used upfront before catheter ablation.
May support denervation in refractory VT storm; leaves open efficacy confirmation in randomized trials.
Background Surgical Cardiac Sympathetic Denervation (CSD) is a procedure which involves surgical removal of terminal cervical and thoracic sympathetic ganglion for reducing sympathetic discharge to the heart. CSD is usually performed as a last desperate measure in treatment of ventricular tachycardia (VT). We report here the clinical profile and long-term follow-up of all our patients who underwent CSD (unilateral or bilateral) predominantly upfront prior to considering catheter ablation of VT for VT storm. Material and methods We retrospectively collected data of all patients who underwent CSD for VT storm between year 2010 till 2019. Success of CSD was defined as successful discharge of patient from the hospital after the procedure more than 75% decrease in the frequency of VT after two weeks of surgical procedure. Results A total of 65 patients underwent CSD in the above-mentioned period and the average duration of follow-up was 28 months. The clinical parameters, demographic data and outcome analysis is provided in details in table 1. Only 14 (21.5%) patients underwent attempt of catheter ablation of VT prior to considering CSD. CSD was successful in 53 (81.5%) of patients. There was a significant decline in the incidence of number of ICD or external shocks before and after CSD (25.2±39.4 vs 1.09±2.9) respectively. There was no significant effect of CSD on ejection fraction. None of the available clinical parameters predicted the success of CSD. Discussion and conclusion The current retrospective analysis reemphasize the role of surgical CSD in treatment of patients with VT storm. As in predominant patient's CSD was performed even before the attempting catheter-based ablation, it brings in a new dimension in the treatment of VT. Efficacy of CSD (81.5%) in experienced hand is equivalent or even better than catheter-based ablation in patients with VT storm. Funding Acknowledgement Type of funding source: None
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Barwad et al. (2020) conducted a cohort in VT storm (n=65). Surgical Cardiac Sympathetic Denervation (CSD) vs. Before CSD (baseline) was evaluated on Success of CSD (successful hospital discharge and >75% decrease in VT frequency after two weeks). Surgical cardiac sympathetic denervation was successful in 81.5% of patients with VT storm and significantly reduced the incidence of ICD or external shocks (25.2 vs 1.09).
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