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Cauti FM, Rossi P, Bianchi S, Magnocavallo M, Capone S, Della Rocca DG, Polselli M, Bruno K, Tozzi P, Rossi C, Vannucci J, Pugliese F, Quaglione R, Venuta F, Anile M. Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01706-6. [PMID: 38040851 DOI: 10.1007/s10840-023-01706-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT). OBJECTIVES Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT. METHODS All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT. RESULTS We enrolled 15 patients (age: 69.2 ± 7.9 years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4 min per side; no major periprocedural complication occurred. After a median follow-up time of 15 months (IQR: 8.5-24.5 months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340 ms were associated with better outcomes. CONCLUSIONS A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy.
| | - Pietro Rossi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | | | - Silvia Capone
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard - Heart, Brussels, Belgium
| | - Marco Polselli
- Arrhythmology Unit, Fatebenefratelli Isola - Gemelli Isola, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Sapienza University, Rome, Italy
| | | | - Chiara Rossi
- Presidio Ospedaliero Santo Spirito in Sassia, Rome, Italy
| | - Jacopo Vannucci
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | | | - Raffaele Quaglione
- Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Federico Venuta
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
| | - Marco Anile
- Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy
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Cauti FM, Capone S, Rossi P, Polselli M, Venuta F, Vannucci J, Bruno K, Pugliese F, Tozzi P, Bianchi S, Anile M. Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01404-9. [PMID: 36282370 DOI: 10.1007/s10840-022-01404-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/19/2022] [Indexed: 10/31/2022]
Abstract
Cardiac sympathetic denervation (CSD) is a valuable option in the setting of refractory ventricular arrhythmias in patient with structural heart disease. Since the procedure was introduced for non structural heart disease patients the techniques evolved and were modified to be adopted in several settings. In this state-of-the-art article we revised different techniques, their rationale, strengths, and pitfalls.
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Affiliation(s)
- Filippo Maria Cauti
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy.
| | - Silvia Capone
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
- Cardiology Unit, Dipartimento Cuore E Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pietro Rossi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Polselli
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Federico Venuta
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Jacopo Vannucci
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Katia Bruno
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Francesco Pugliese
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Pierfrancesco Tozzi
- Department of Anesthesiology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Stefano Bianchi
- Arrhythmology Unit, Ospedale San Giovanni Calibita, Fatebenefratelli Isola Tiberina, Via Ponte Quattro Capi 39, 00186, Rome, Italy
| | - Marco Anile
- Thoracic Unit, Policlinico Umberto I, Sapienza University, Rome, Italy
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Stewart JR. Limited Left Thoracoscopic Sympathectomy for Electrical Storm: A Valuable Addition to the Armamentarium of Arrhythmia Management. Ann Thorac Surg 2021; 113:223-224. [PMID: 33675707 DOI: 10.1016/j.athoracsur.2021.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/01/2022]
Affiliation(s)
- James R Stewart
- Department of Surgery, University of Missouri-Kansas City School of Medicine, 2301 Holmes St, Kansas City, MO 64108.
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