Bilateral thoracoscopic cardiac sympathetic denervation in patients with refractory ventricular tachyarrhythmias non‑responsive to other treatment.

Objectives:  To explore the efficacy and safety of bilateral thoracoscopic cardiac sympathetic denervation (BTCSD) as an underutilised last‑resort surgical technique for patients with ventricular tachyarrhythmias and electrical storm non-responsive to other treatment.

Background:  Patients with refractory ventricular tachycardia, ventricular fibrillation, and electrical storm are at high risk of sudden cardiac death. In some patients, suboptimal results are achieved despite treatment with anti-arrhythmic drugs, implantable cardioverter-defibrillator and cardiac catheter ablation. Minimally invasive surgery affecting the stellate ganglions and sympathetic chain is an additional alternative treatment modality that may help avoid heart transplantation.

Methods:  We present our experience of 3 patients who were treated with this technique for the first time in Slovakia in cooperation with the National Institute for Cardiovascular Diseases. Publications on this issue are scarce despite its potential for specific patients. Modifications to avoid complications derived from our experience of sympathectomies for hyperhidrosis are introduced, and improvements are proposed to promote this technique.

Results:  All patients showed a reduction or cessation of arrhythmias and ICD shocks with no periprocedural complications.

Conclusion:  Our experience showed that BTCSD is a safe and feasible technique with a low complication rate and promising results. The limitation of this paper is the low number of patients in our group (Tab. 1, Fig. 3, Ref. 25).