Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, IL, USA.
Division of Cardiology, Department of Internal Medicine, University of Arizona, Phoenix, AZ, USA.
Interact Cardiovasc Thorac Surg. 2022 May 2;34(5):783-790. doi: 10.1093/icvts/ivab372.
Thoracic sympathectomy has been shown to be effective in reducing implantable cardioverter-defibrillator (ICD) shocks and ventricular tachycardia recurrence in patients with channelopathies, but the evidence supporting its use for refractory ventricular arrhythmias in patients without channelopathies is limited. This is a single-centre cohort study of bilateral R1-R4 thoracoscopic sympathectomy for medically refractory ventricular arrhythmias.
Clinical information was examined for all bilateral thoracoscopic R1-R4 sympathectomies for ventricular arrhythmias at our institution from 2016 through 2020.
Thirteen patients underwent bilateral thoracoscopic R1-R4 sympathectomy. All patients had prior ICD implant. Patients had a recent history of multiple ICD discharges (12/13), catheter ablation (10/13) and cardiac arrest (3/13). Ten patients were urgently operated on following transfer to our centre for sustained ventricular tachycardia. Seven patients had ventricular tachycardia ablations preoperatively during the same admission. Five patients were in intensive care immediately preoperatively, with 3 requiring mechanical ventilation. Three patients suffered in-hospital mortality. Kaplan-Meier analysis estimated 73% overall survival at 24-month follow-up. Among the 10 patients who survived to discharge, all were alive at a median follow-up of 8.7 months (interquartile range 0.6-26.7 months). Six of 10 patients had no further ICD discharges. Kaplan-Meier analysis estimated 27% ICD shock-free survival at 24 months follow-up for all patients. Three of 10 patients had additional ablations, while 2 patients underwent cardiac transplantation.
Bilateral thoracoscopic sympathectomy is an effective option for patients with life-threatening ventricular arrhythmia refractory to pharmacotherapy and catheter ablation.
胸腔交感神经切除术已被证明可有效减少通道病患者植入式心脏复律除颤器（ICD）电击和室性心动过速复发，但对于无通道病患者难治性室性心律失常支持其使用的证据有限。这是一项针对我院 2016 年至 2020 年所有双侧胸腔镜 R1-R4 交感神经切除术治疗药物难治性室性心律失常的单中心队列研究。
对我院所有双侧胸腔镜 R1-R4 交感神经切除术治疗室性心律失常的患者进行临床信息检查。
13 例患者接受了双侧胸腔镜 R1-R4 交感神经切除术。所有患者均植入了 ICD。患者近期 ICD 放电次数多（12/13）、导管消融（10/13）和心脏骤停（3/13）。10 例患者因持续性室性心动过速转移至我院后紧急手术。7 例患者在同一入院期间行术前室性心动过速消融术。5 例患者术前立即入住重症监护病房，其中 3 例需要机械通气。3 例患者院内死亡。Kaplan-Meier 分析估计 24 个月随访时总体生存率为 73%。在 10 例存活至出院的患者中，所有患者在中位随访 8.7 个月（四分位距 0.6-26.7 个月）时仍存活。10 例患者中有 6 例无进一步 ICD 放电。Kaplan-Meier 分析估计所有患者 24 个月随访时 ICD 无电击生存率为 27%。10 例患者中有 3 例接受了额外的消融治疗，2 例接受了心脏移植。
双侧胸腔镜交感神经切除术是一种治疗药物难治性危及生命的室性心律失常的有效方法，适用于药物治疗和导管消融。
