Krause E, Appelbaum J, Naselsky W, Dickfeld T, Friedberg J, See V, Burrows W. Limited Left Thoracoscopic Sympathectomy Effectively Silences Refractory Electrical Storm.
Ann Thorac Surg 2021;
113:217-223. [PMID:
33545155 DOI:
10.1016/j.athoracsur.2021.01.039]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/20/2020] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND
Electrical Storm is a life-threatening condition that affects up to 20% of patients with ICDs. In this small retrospective study, we report our results with left video-assisted thoracoscopic sympathectomy/ganglionectomy (VATSG) to treat refractory electrical storm in low ejection fraction patients who were not candidates for catheter ablations (CA).
METHODS
We identified 12 patients who presented with electrical storm and underwent a total of 14 video assisted thoracoscopic sympathectomy/ganglionectomy, including three patients on venoarterial extracorporeal membrane oxygenation (VA ECMO). We reviewed demographic data, survival to discharge, number of cardioversions (before and after VATSG), need for readmissions, and need for right-sided procedures.
RESULTS
In the 30 days prior to a left VATSG the mean number of shocks was 22.67 for all patients. For the patients who survived to discharge the mean was 3.55 since surgery with a median of zero shocks after a median follow up of 358 days. Six patients have not experienced any further cardioversions since their last VATSG and five have never been readmitted for VT. Two patients had staged bilateral procedures due to recurrences and of those, one never required any further cardioversions.
CONCLUSIONS
Limited left VATSG is an appropriate and effective initial treatment for ES patients who are not candidates for CA, including patients on VA ECMO for hemodynamic support.
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