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Safety and efficacy of thoracoscopic sympathectomy for control of recurrent ventricular tachycardia in patients mainly with Chagas disease.
  • +9
  • Rodrigo Kulchetscki,
  • Felipe Alexandre,
  • Marina Mayrink,
  • Carina Hardy,
  • Sissy de Melo,
  • Muhieddine Chokr,
  • Luis Abdalla,
  • Martino Martinelli Filho,
  • Francisco Darrieux,
  • Cristiano Pisani,
  • Mauricio Ibrahim Scanavacca,
  • Paulo Pêgo-Fernandes
Rodrigo Kulchetscki
University of São Paulo Medical School
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Felipe Alexandre
University of São Paulo Medical School
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Marina Mayrink
University of São Paulo Medical School
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Carina Hardy
Heart Institute
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Sissy de Melo
University of São Paulo Medical School
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Muhieddine Chokr
University of São Paulo Medical School
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Luis Abdalla
University of São Paulo Medical School
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Martino Martinelli Filho
Heart Institute (InCor) University of Sao Paulo Medical School
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Francisco Darrieux
University of São Paulo Medical School, Arrhythmia Unit São Paulo, SP, BR
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Cristiano Pisani
Heart Institute, University of São Paulo Medical School
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Mauricio Ibrahim Scanavacca
Cardiac Arrhythmias and Electrophysiology Unit, Heart Institute, University of Sao Paulo Medical School, São Paulo, Brazil
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Paulo Pêgo-Fernandes
University of Sao Paulo Heart Institute
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Abstract

Introduction: The autonomous system plays an important role as a trigger of cardiac arrhythmias. Cardiac sympathetic denervation (CSD) achieved by stellate and proximal thoracic ganglia resection has been reported as an alternative approach for the management of ventricular arrhythmias (VA) in structural heart disease (SHD) patients. Insufficient data regarding Chagas Disease (ChD) is available. Methods: Patients who underwent CSD for better management of ventricular arrhythmias (VA) in SHD, mainly ChD, in a single tertiary center in Brazil were evaluated for safety and efficacy outcomes. Results: Between June 2014 and March 2020, fourteen patients (age 59±7.5, 85% male, mean ejection fraction 30.5±7.9%) were submitted to left or bilateral CSD. In a median follow-up time of 143 (Q1: 30; Q3: 374) days, eight patients (57,2%) presented VT recurrence. A significant reduction in the median burden of ventricular arrhythmias comparing six months before and after procedure (10 to 0; p=0.004). For the nine ChD patients, the median burden of appropriate therapies was also reduced (11 to 0; p=0.008). There were two cases of clinically relevant pneumothorax and three cases of transient hemodynamic instability, but no direct procedure-related deaths occurred. Additionally, there was no long-term adverse events, Conclusion: CSD is safe and seems to be effective in reducing the burden of VT/VT storm in SHD patients, including ChD patients. Randomized trials are needed to clarify its role in the management of these patients.