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Long term clinical outcome of Cardiac Sympathetic Denervation in patients with refractory ventricular arrhythmias
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  • Parag Barwad,
  • Kunal Sinkar,
  • Neeta Bachani,
  • Rushil Shah,
  • Vihang Shah,
  • Binay Kumar,
  • Shrikant Bhoskar,
  • Neeraj Desai,
  • Yash Lokhandawala
Parag Barwad
Post Graduate Institute of Medical Education and Research
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Kunal Sinkar
Bandra Holy Family Hospital and Research Centre
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Neeta Bachani
Bandra Holy Family Hospital and Research Centre
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Rushil Shah
Johns Hopkins University School of Medicine
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Vihang Shah
Bandra Holy Family Hospital and Research Centre
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Binay Kumar
Bandra Holy Family Hospital and Research Centre
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Shrikant Bhoskar
Bandra Holy Family Hospital and Research Centre
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Neeraj Desai
Bandra Holy Family Hospital and Research Centre
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Yash Lokhandawala
Arrhythmia Associates
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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.

Peer review status:IN REVISION

21 Jun 2020Submitted to Journal of Cardiovascular Electrophysiology
22 Jun 2020Submission Checks Completed
22 Jun 2020Assigned to Editor
22 Jun 2020Reviewer(s) Assigned
06 Jul 2020Review(s) Completed, Editorial Evaluation Pending
06 Jul 2020Editorial Decision: Revise Minor
25 Aug 20201st Revision Received
28 Aug 2020Submission Checks Completed
28 Aug 2020Assigned to Editor
28 Aug 2020Reviewer(s) Assigned
04 Sep 2020Review(s) Completed, Editorial Evaluation Pending
04 Sep 2020Editorial Decision: Revise Minor