Key result
Bilateral video-assisted thoracoscopic cardiac denervation resulted in a 90% total resolution of ICD registered shocks and a 100% resolution of electrical storms during the first three months post-procedure.
Why the study?
Some patients with ventricular arrhythmias remain refractory to beta-blockers, ablation, and ICD therapy, and video-assisted thoracoscopic cardiac denervation has emerged as a potential therapeutic option.
Does bilateral VATS cardiac denervation reduce ICD shocks and electrical storms in patients with refractory ventricular arrhythmias?
Case Report (n=20)
No
Does bilateral VATS cardiac denervation reduce ICD shocks and electrical storms in patients with refractory ventricular arrhythmias?
Bilateral thoracoscopic cardiac denervation appears to be a safe and highly effective therapeutic option for reducing ICD shocks and electrical storms in patients with refractory ventricular arrhythmias.
May reduce ICD shocks in refractory VT; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: The combined treatment of beta-blockers with ablation and Implanted cardioverter defibrillation therapy, continues to be the mainstay treatment for ventricular arrhythmias (VAs). Despite treatment, some patients remain refractory. Recent studies have shown success rates using video-assisted thoracoscopic (VATS) cardiac denervation as an effective therapeutic option for these patients. CASE SERIES PRESENTATION: During a period of three years, from 2015 through 2017, twenty patients (N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. The patients were refractory to combined medical (beta-blockers), Implanted Cardioverter defibrillation (ICD) and ablation therapy. All twenty patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. During the month prior to bilateral VATS denervation a combined total of twenty-nine (N = 29) ICD shocks were registered in addition to six (N = 6) cases of electrical storms averaging three (N = 3) shocks per day. Mean shocks per patient was 2.3. During the first three months following VATS, the patients had a 90% (N = 18/20) total resolution of ICD registered shocks, a 100% (N = 6/6) resolution of electrical storms, and a 92% (N = 11/12) resolution of shocks in patients having previous ablation therapy. No complications were documented following surgery except for one case of pneumothorax as a result of the procedure, and there were no peri-operative mortalities. CONCLUSIONS: Bilateral thoracoscopic cardiac denervation can be a safe and seemingly effective therapeutic option for patients presenting with life-threatening refractory ventricular arrhythmias and electrical storms in a variety of cardiomyopathies including Chagas disease.
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Téllez et al. (2019) conducted a case report in Refractory ventricular arrhythmias and electrical storms (n=20). Bilateral video-assisted thoracoscopic (VATS) cardiac denervation vs. Pre-operative baseline was evaluated on Resolution of ICD registered shocks during the first three months following VATS. Bilateral video-assisted thoracoscopic cardiac denervation resulted in a 90% total resolution of ICD registered shocks and a 100% resolution of electrical storms during the first three months post-procedure.
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