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Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

Graphical abstract

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

Abbreviations

ANS:

Autonomic nervous system

ATP:

Antitachycardia pacing

CA:

Catheter ablation

COPD:

Chronic obstructive pulmonary disease

CSD:

Cardiac sympathetic denervation

LVEF:

Left ventricular ejection fraction

ICD:

Implantable cardioverter defibrillator

SG:

Stellate ganglion

SGB:

Stellate ganglion blockade

SHD:

Structural heart disease

TEA:

Thoracic epidural anesthesia

TcMS:

Transcranic magnetic stimulation

VA:

Ventricular arrhythmia

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

References

  1. Cauti FM, Rossi P, Sommer P. The sympathetic nervous system and ventricular arrhythmias: an inseparable union. Eur Heart J. 2021;42:3588–90.

    Article  PubMed  Google Scholar 

  2. Bradfield JS, Ajijola OA, Vaseghi M, Shivkumar K. Mechanisms and management of refractory ventricular arrhythmias in the age of autonomic modulation. Heart Rhythm. 2018;15:1252–60.

    Article  PubMed  Google Scholar 

  3. Markman TM, Pothineni NVK, Zghaib T, et al. Effect of transcutaneous magnetic stimulation in patients with ventricular tachycardia storm: a randomized clinical trial. JAMA Cardiol. 2022;7:445.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm. 2018;15:e73–189.

    Article  PubMed  Google Scholar 

  5. Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022;43:3997–4126.

    Article  PubMed  Google Scholar 

  6. Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. J Interv Card Electrophysiol. 2020;59:81–133.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Vaseghi M, Barwad P, Malavassi Corrales FJ, et al. Cardiac sympathetic denervation for refractory ventricular arrhythmias. J Am Coll Cardiol. 2017;69:3070–80.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cauti FM, Capone S, Rossi P, et al.: Cardiac sympathetic denervation for untreatable ventricular tachycardia in structural heart disease. Strengths and pitfalls of evolving surgical techniques. J Interv Card Electrophysiol [Internet] 2022 [cited 2022 Nov 1]; . Available from: https://link.springer.com/https://doi.org/10.1007/s10840-022-01404-9

  9. Cauti FM, Rossi P, Bianchi S, et al. Outcome of a modified sympathicotomy for cardiac neuromodulation of untreatable ventricular tachycardia. JACC Clin Electrophysiol. 2021;7:442–9.

    Article  PubMed  Google Scholar 

  10. Wilde AAM, Bhuiyan ZA, Crotti L, et al. Left cardiac sympathetic denervation for catecholaminergic polymorphic ventricular tachycardia. N Engl J Med. 2008;358:2024–9.

    Article  CAS  PubMed  Google Scholar 

  11. Téllez LJ, Garzón JC, Vinck EE, Castellanos JD. Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: a single-center series. J Cardiothorac Surg. 2019;14:17.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Irie T, Yamakawa K, Hamon D, Nakamura K, Shivkumar K, Vaseghi M. Cardiac sympathetic innervation via middle cervical and stellate ganglia and antiarrhythmic mechanism of bilateral stellectomy. Am J Physiol-Heart Circ Physiol. 2017;312:H392–405.

    Article  PubMed  Google Scholar 

  13. Douketis JD, Spyropoulos AC: perioperative management of anticoagulant and antiplatelet therapy. Hardin CC, ed: NEJM Evid [Internet] 2023 [cited 2023 Jul 25]; 2. Available from: https://evidence.nejm.org/doi/https://doi.org/10.1056/EVIDra2200322

  14. Krause EM, Appelbaum J, Naselsky W, et al. Limited left thoracoscopic sympathectomy effectively silences refractory electrical storm. Ann Thorac Surg. 2022;113:217–23.

    Article  PubMed  Google Scholar 

  15. Cauti FM, Rossi P, Anile M. Increasing Evidence of Limited Cardiac Sympathetic Denervation for Refractory Ventricular Tachycardia. Ann Thorac Surg. 2022;114(6):2405–6. https://doi.org/10.1016/j.athoracsur.2022.01.025.

  16. Cauti FM, Rossi P, Polselli M, et al. Reply JACC Clin Electrophysiol. 2021;7:1071–2.

    Article  PubMed  Google Scholar 

  17. Halder A, Gandhi J, Chaudhari S, Parikh H, Shinde H, Lokhandwala Y. Significance of stellate ganglion removal during cardiac sympathetic denervation. JACC Clin Electrophysiol. 2021;7:1070–1.

    Article  PubMed  Google Scholar 

  18. Cauti FM, Rossi P, Stefano Bianchi. Neuromodulation Strategies for Refractory Ventricular Arrhythmias: Time to “Tune” the Volume? JACC Clin Electrophysiol. 2023;9(2):170–72. https://doi.org/10.1016/j.jacep.2022.11.002.

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Author notes

  1. Filippo Maria Cauti and Pietro Rossi equally contributed to this paper.

Authors and Affiliations

  1. Arrhythmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Filippo Maria Cauti

  2. Cardiology Unit, Dipartimento Cuore e Grossi Vasi, Policlinico Umberto I, Sapienza University, Rome, Italy

    Filippo Maria Cauti & Raffaele Quaglione

  3. Arrhythmology Unit, Fatebenefratelli Isola – Gemelli Isola, Rome, Italy

    Pietro Rossi, Stefano Bianchi, Michele Magnocavallo, Silvia Capone & Marco Polselli

  4. Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard – Heart, Brussels, Belgium

    Domenico Giovanni Della Rocca

  5. Department of Anesthesiology, Sapienza University, Rome, Italy

    Katia Bruno, Pierfrancesco Tozzi & Francesco Pugliese

  6. Presidio Ospedaliero Santo Spirito in Sassia, Rome, Italy

    Chiara Rossi

  7. Division of Thoracic Surgery and Lung Transplant, Sapienza University, Rome, Italy

    Jacopo Vannucci, Federico Venuta & Marco Anile

Authors
  1. Filippo Maria Cauti
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  2. Pietro Rossi
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  4. Michele Magnocavallo
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  7. Marco Polselli
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  15. Marco Anile
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Corresponding author

Correspondence to Filippo Maria Cauti.

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Ethical approval

The study protocol was approved by the local ethics committee.

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Written informed consent from all patients was obtained before each procedure.

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The authors declare no competing interests.

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Cauti, F.M., Rossi, P., Bianchi, S. et al. Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience. J Interv Card Electrophysiol (2023). https://doi.org/10.1007/s10840-023-01706-6

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