Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias: a single-center experience

Abstract Background Cardiac sympathetic denervation (CSD) is a therapeutic option in patients with refractory ventricular arrhythmias (VAs). However, prospective data on long term outcomes in different population cohorts undergoing CSD are scarce. Purpose The aim of this study is to evaluate acute results, complications, and long-term outcomes of CSD as a bailout therapy for VAs refractory to catheter ablation. Methods Adult patients who underwent CSD from October 2015 to February 2020 were retrospectively analyzed. Follow-up was conducted via implantable cardioverter defibrillator (ICD) interrogation and reviewing medical records. Results A total of 15 patients (mean age 41.8 ± 21.1, 33.3% female) with nonischemic dilated cardiomyopathy (N = 5), idiopathic ventricular fibrillation (N = 4), catecholaminergic polymorphic ventricular tachycardia (N=3), Long QT syndrome (N=2) and Brugada syndrome overlap with long QT (N=1) underwent CSD (left sided in 2 and bilateral in 13 patients). All patients had refractory VAs despite multiple anti-arrhythmic drugs and prior VAs ablation (mean number of procedures was 3.4 ± 1.8). At a mean follow-up of 80.3 ± 17.7 months, 66.7% and 80% of patients were free from any VAs or ICD shocks, respectively. Two patients experienced single ICD shock due to a monomorphic ventricular tachycardia (VT). One patient experienced multiple anti-tachycardia pacing bursts and shocks due to polymorphic VT. No major complications of CSD occurred. No patient suffered from Horner syndrome. Conclusion The current retrospective analysis re-emphasizes the role of surgical CSD to suppress VAs, when performed as a bailout therapy after previously unsuccessful catheter ablation. Further studies are needed to validate this finding in a prospective setting.