Mittal Sonali, Deepti Siddharthan, Abraham Joyner, Kashyap Lokesh, Suhani Suhani, Parshad Rajinder
Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029 India.
Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029 India.
Indian J Thorac Cardiovasc Surg. 2022 Sep;38(5):515-520. doi: 10.1007/s12055-022-01361-y. Epub 2022 May 17.
Cardiac sympathetic denervation (CSD) is a useful therapeutic option for patients with ventricular arrhythmias (VAs) refractory to anti-arrhythmic agents and/or catheter ablation. However, the experience is mostly limited to non-structural heart disease in paediatric patients. The advent of video-assisted thoracoscopic surgery (VATS) with its reduced morbidity has encouraged the use of VATS CSD in patients with structural heart disease. In this series, we report the surgical and cardiac outcomes of VATS-guided CSD in four patients who presented with electrical storm in the setting of different structural cardiomyopathies. Four patients underwent VATS-guided CSD at our centre during the period 2019-2021 after failure of conventional medical and/or ablative treatment for the management of refractory VAs. All four patients presented with electrical storm with different cardiomyopathies including ischaemic (post-acute myocardial infarction) and non-ischaemic aetiologies (sarcoidosis, non-specific right ventricular cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy). A combined total of 349 implantable cardioverter defibrillator (ICD) shocks were registered in the 4 weeks preceding the procedure with mean shocks of 87 per patient. All four patients successfully underwent CSD through the VATS approach with no operative mortality or any major surgical morbidity. All patients had resolution of electrical storms with 75% of patients remaining free of ICD shocks at a mean follow-up of 14.87 months. One patient who remained free of ICD shocks and recurrent VAs died at 23 months after the procedure due to progressive heart failure and complications. VATS CSD is a safe and effective complementary therapeutic modality in patients with life-threatening refractory VAs and electrical storms irrespective of the underlying substrate.
The online version contains supplementary material available at 10.1007/s12055-022-01361-y.
心脏交感神经去神经支配术（CSD）对于对抗心律失常药物和/或导管消融难治的室性心律失常（VA）患者是一种有用的治疗选择。然而，这种经验大多限于儿科患者的非结构性心脏病。电视辅助胸腔镜手术（VATS）发病率降低，其出现鼓励了在结构性心脏病患者中使用VATS CSD。在本系列中，我们报告了4例在不同结构性心肌病背景下出现电风暴的患者接受VATS引导下CSD的手术和心脏结局。2019年至2021年期间，4例患者在常规药物和/或消融治疗未能控制难治性VA后，在我们中心接受了VATS引导下的CSD。所有4例患者均出现电风暴，患有不同的心肌病，包括缺血性（急性心肌梗死后）和非缺血性病因（结节病、非特异性右室心肌病和致心律失常性右室心肌病）。在手术前4周内，总共记录到349次植入式心脏复律除颤器（ICD）电击，平均每位患者87次。所有4例患者均通过VATS方法成功接受了CSD，无手术死亡或任何重大手术并发症。所有患者的电风暴均得到缓解，平均随访14.87个月时，75%的患者未再发生ICD电击。1例未再发生ICD电击和复发性VA的患者在手术后23个月因进行性心力衰竭和并发症死亡。无论潜在病因如何，VATS CSD对于有生命危险的难治性VA和电风暴患者是一种安全有效的补充治疗方式。
在线版本包含可在10.1007/s12055-022-01361-y获取的补充材料。
