Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias

Abstract

Background: The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. Methods: This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45–65 years) and a median ejection fraction of 58.5% (IQR, 56.2%–60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. Results: The median hospital stay after surgery was 2 days (IQR, 2–3 days). The median surgical time for BCSD was 113 minutes (IQR, 104–126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5–28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. Conclusion: The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.

Keywords

• sympathectomy
• cardiac arrhythmias
• video-assisted thoracic surgery