Left sympathetic cardiac denervation in managing electrical storm: acute outcome and long term follow up

PURPOSE

Left sympathetic cardiac denervation (LSCD) may be beneficial in treating electrical storm (ES) of varied aetiologies. The present study analyse the outcome and long term follow up of LSCD in treating ES.

METHODS

This is a retrospective study of patients with ES who underwent LSCD.

RESULTS

Nine patients (majority males (88.89 %), median age 52 years, IQR 50.5-56.5) underwent LSCD. Coronary artery disease was the commonest substrate (7 (77.78 %)). Five patients, who had hypotension and unstable hemodynamics, underwent percutaneous stellate ganglion blockade. Three of the survivors subsequently underwent surgical sympathectomy. In the remaining four, video assisted thoracoscopy (VATS) guided sympathectomy was performed. Five (55 %) and seven (77.78 %) had a >90 and 80 % reduction in ventricular arrhythmias (VA), respectively. LSCD was ineffective in one patient, who succumbed to ES. There was no difference in outcome between patients with monomorphic versus polymorphic VA (60 vs 70 %, respectively, p = 0.82). One (11.1 %) patient had sudden death on the fifth day after LSCD. The median hospital stay was 13 days (IQR 11-16). During median 34 months of (IQR 18-46) follow up, one patient died of heart failure, and another had recurrence of ES. There was sustained reduction in VA burden in others.

CONCLUSION

LSCD is effective in controlling ES and continues to reduce the incidence of VAs during long term follow up. Pharmacological LSCD needs particular emphasis, as it can be performed at bedside, and can be a bail-out procedure in centres where sophisticated procedures like VATS-guided LSCD or radiofrequency ablation are not readily available.