title: Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up.
abstract: BACKGROUND
  Left and bilateral cardiac sympathetic denervation (CSD) have been shown to reduce burden of ventricular arrhythmias acutely in a small number of patients with ventricular tachyarrhythmia (VT) storm. The effects of this procedure beyond the acute setting are unknown.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the intermediate and long-term effects of left and bilateral CSD in patients with cardiomyopathy and refractory VT or VT storm.
  
  
  METHODS
  Retrospective analysis of medical records for patients who underwent either left or bilateral CSD for VT storm or refractory VT between April 2009 and December 2012 was performed.
  
  
  RESULTS
  Forty-one patients underwent CSD (14 left CSD, 27 bilateral CSD). There was a significant reduction in the burden of implantable cardioverter-defibrillator (ICD) shocks during follow-up compared to the 12 months before the procedure. The number of ICD shocks was reduced from a mean of 19.6 ± 19 preprocedure to 2.3 ± 2.9 postprocedure (P < .001), with 90% of patients experiencing a reduction in ICD shocks. At mean follow-up of 367 ± 251 days postprocedure, survival free of ICD shock was 30% in the left CSD group and 48% in the bilateral CSD group. Shock-free survival was greater in the bilateral group than in the left CSD group (P = .04).
  
  
  CONCLUSIONS
  In patients with VT storm, bilateral CSD is more beneficial than left CSD. The beneficial effects of bilateral CSD extend beyond the acute postsympathectomy period, with continued freedom from ICD shocks in 48% of patients and a significant reduction in ICD shocks in 90% of patients.
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California. Electronic address: mvaseghi@mednet.ucla.edu.
authors.forename: Marmar
authors.initials: M
authors.lastname: Vaseghi
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Jean
authors.initials: J
authors.lastname: Gima
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kanaan
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Olujimi A
authors.initials: OA
authors.lastname: Ajijola
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California; Division of Cardiothoracic Surgery, Los Angeles, California.
authors.forename: Alexander
authors.initials: A
authors.lastname: Marmureanu
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California; Department of Anesthesiology, UCLA Health System, Los Angeles, California.
authors.forename: Aman
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: UCLA Cardiac Arrhythmia Center, Los Angeles, California.
authors.forename: Kalyanam
authors.initials: K
authors.lastname: Shivkumar
mesh_terms: D001145:Arrhythmias, Cardiac / Q000601:surgery*; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013562:Sympathectomy / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000601:surgery; D016896:Treatment Outcome
keywords: Cardiac denervation; Electrical storm; Sympathectomy; Ventricular arrhythmias