# Simplified left cardiac sympathetic denervation as an acute strategy for recurrent ventricular tachycardia in multimorbid patients with structural heart disease: A case series

## TL;DR

A simplified cardiac denervation procedure reduced dangerous heart rhythms in patients with heart disease who did not respond to other treatments.

## Contribution

A less invasive cardiac sympathetic denervation approach targeting left thoracic ganglia was evaluated for drug-resistant ventricular arrhythmias.

## Key findings

- LCSD reduced VA episodes requiring ICD therapy from 14 to 2 over 7 months.
- ICD shocks decreased from 1.5 to 0 during follow-up.
- Procedure was performed safely with minimal complications in multimorbid patients.

## Abstract

Cardiac sympathetic denervation as a treatment for drug-refractory ventricular arrhythmias (VAs) involves video-assisted thoracoscopic removal of the stellate ganglion (SG) and thoracic ganglia. A simplified approach sparing the SG and targeting left T2–T4 ganglia (left cardiac sympathetic denervation [LCSD]) may offer a less invasive alternative.

This study aimed to evaluate the efficacy and safety of simplified SG-sparing LCSD as a bailout procedure for multimorbid patients with structural heart disease and recurrent VAs refractory to antiarrhythmic drugs and/or catheter ablation.

All patients undergoing SG-sparing LCSD at our institution between June 2023 and June 2024 were included in this single-center retrospective study. Baseline demographics, procedural complications, and arrhythmia outcomes were analyzed.

LCSD was performed in 7 patients (mean age 75.9 ± 6.7 years, mean LVEF 30.7 ± 10.9%) with structural heart disease (nonischemic cardiomyopathy, n = 3; ischemic cardiomyopathy, n = 4) mostly 1 day (interquartile range 1–21) after admission with a procedure duration of 20.7 ± 5.3 minutes. Initially, 4 patients (57.1%) had electrical storm. Apart from 1 pleural effusion requiring drainage, no major complications or Horner’s syndrome occurred. During a follow-up of 7 ± 2.6 months, median VA episodes requiring implantable cardioverter-defibrillator therapy decreased from 14 to 2 (P = .021) and median implantable cardioverter-defibrillator shocks from 1.5 to 0 (P = .034). Three patients remained free of sustained VAs; 1 patient died of coronavirus disease 2019.

In this case series of 7 patients, SG-sparing LCSD demonstrated promising results in terms of safety and efficacy for reducing VAs. Further studies are warranted to confirm long-term outcomes with this approach.