The effect of bilateral cardiac sympathetic denervation for refractory ventricular tachycardia in ischemic cardiomyopathy

Figures

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  FIGURE 1. A, 12‐lead ECG showed A paced, V paced. B, 12‐lead ECG showed clinical VT. VT CL was 430 ms C, RAO view of substrate mapping with voltage criteria of 0.2‐0.6 mV for the LVA. Substrate mapping during right ventricular pacing with a CARTO system was performed using a multielectrode catheter. LVA was observed on the inferior and lateral LV wall. Perfect pace‐mapping was obtained at ostium of the RCA. Electrophysiological findings suggested that the ventricular myocardium captured by RCC was close to the exit site of the reentrant circuit of VT. RF energy was applied for RCC and left ventricle on the opposite side of the RCC and abandoned it for the ostium of the RCA where the perfect match of pace‐mapping was obtained. blue circle, site of pace‐mapping at RCC; CL, cycle length; Eg‐QRS, electrogram‐QRS intervals; PPI, postpacing interval; RAO, right anterior oblique; RCA, right coronary artery; RCC, right coronary cusp; red circle, ablation site; RF, radiofrequency; Sti‐QRS, stimulus‐QRS intervals; VT, ventricular tachycardia

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  FIGURE 2. A, Two days after ablation, electrical VT storm recurred following cessation of sedation. Continuous telemetry rhythm strip showed 11 antitachycardia pacing therapies and 1 defibrillation within 8 min. B, Videoscopic still frame of VATS‐right CSD demonstrated the sympathetic chain from the second to the fifth thoracic ganglion before resection. C, The right sympathetic chain from the second to the fifth thoracic ganglion was resected. CSD, cardiac sympathetic denervation; VATS, video‐assisted thoracoscopic surgery; VT, ventricular tachycardia