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01-01-2021 | Antiarrhythmic Drugs | Original Paper

Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience

Authors: Kivanc Yalin, Spyridon Liosis, Emanuel Palade, Thomas Fink, Stefanie Schierholz, Noureddin Sawan, Charlotte Eitel, Christian H. Heeger, Vanessa Sciacca, Makoto Sano, Julia Vogler, Roland Richard Tilz

Published in: Clinical Research in Cardiology | Issue 1/2021

Introduction

Cardiac sympathetic denervation (CSD) is an effective therapy for selected patients with drug refractory ventricular arrhythmias (VA). Data about the role of CSD in patients with structural heart disease and VAs are sparse. We herein present our experience of CSD in patients with nonischemic cardiomyopathy and VAs despite prior ablation procedure and/or antiarrhythmic drug (AAD) therapy.

Methods

A total of ten patients (mean age 61.6 ± 19.6, mean LVEF 29.5 ± 12.1%) with nonischemic dilated cardiomyopathy (NICM) (n = 9) and hypertrophic cardiomyopathy (HCM) (n = 1) underwent CSD (left sided in six and bilateral in four patients) due to refractory VA despite multiple AADs (mean number of AADs was 1.6 ± 0.7) and prior VT ablation (mean number of procedures per patient was 1.5 ± 1.3).

Results

Mean follow-up was 10.1 ± 6.9 months. The median number of VA and ICD shocks decreased significantly from 9.0 and 2.5 episodes 6 months prior to CSD to 0 and 0 episodes within 6 months after CSD (p = 0.012 and p = 0.011). Five patients remained free from sustained VA recurrences. Two patients experienced single ICD shock due to a polymorphic VT (triggered by severe hypokalemia in one patient) and one patient a single shock due to monomorphic VT. One patient had five episodes of slow VT under amiodarone therapy (three of them terminated by antitachycardia pacing) and underwent endo- epicardial re-ablation. Two patients died 1 month after CSD. One of them due to electrical storm and cardiogenic shock and the second one due to refractory cardiogenic shock, without recurrence of VAs though. No major complications of CSD occurred. No patient suffered from Horner syndrome.

Conclusion

In this study, CSD was effective for treatment of VAs in patients with structural heart disease refractory to antiarrhythmic drugs and catheter ablation. Further larger studies are required to confirm these findings.

Graphic abstract

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Title: Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience
Authors: Kivanc Yalin
Spyridon Liosis
Emanuel Palade
Thomas Fink
Stefanie Schierholz
Noureddin Sawan
Charlotte Eitel
Christian H. Heeger
Vanessa Sciacca
Makoto Sano
Julia Vogler
Roland Richard Tilz
Publication date: 01-01-2021
Publisher: Springer Berlin Heidelberg
Keywords: Antiarrhythmic Drugs
Neurotomy
Sympathectomy
Cardiomyopathy
Shock
Shock
Cardiogenic Shock
Cardiogenic Shock
Ventricular Tachycardia
Ventricular Fibrillation
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
Published in: Clinical Research in Cardiology / Issue 1/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-020-01643-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cardiac sympathetic denervation in patients with nonischemic cardiomyopathy and refractory ventricular arrhythmias: a single-center experience

Introduction

Methods

Results

Conclusion

Graphic abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Introduction

Methods

Results

Conclusion

Graphic abstract

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