Long term clinical outcome of Cardiac Sympathetic Denervation in
patients with refractory ventricular arrhythmias
Abstract
Background: Cardiac Sympathetic Denervation (CSD) involves surgical
removal of lower half of the stellate ganglion and the T1-T4 ganglia for
reducing sympathetic discharge to the heart. CSD is a useful therapeutic
option in patients with ventricular tachycardia (VT) when they are
non-responsive to standard drug therapy or catheter ablation. We report
here the clinical profile and long-term outcome of all our patients who
underwent CSD for refractory VT or VT storm. Method: Data of all
patients who underwent CSD from 2010 to 2019 was analysed. They were
regularly followed up, focusing on arrhythmia recurrence. Complete
response to CSD was defined as more than 75% decrease in the frequency
of VT. Results: A total of 65 patients (50 male, 15 female) underwent
CSD in the above-mentioned period and the duration of follow-up was
27±24 months. The underlying substrate was for VT was coronary artery
disease in 30 (46.2%) patients and 35 (53.8%) patients had a variety
of other causes. Complete response to CSD was attained in 47 (72.3%)
patients. There was a significant decline in the incidence of number
shocks after CSD (24±37 vs 2±4; p <0.01). Freedom from a
combined end point of ICD shock or death at the end of two years was
51.5%. Advanced NYHA class (III and IV) was the only parameter shown to
have significant association with this combined end point. Conclusion:
The current retrospective analysis reemphasize the role of surgical CSD
in the treatment of patients with refractory VT or VT storm.