Safety and efficacy of thoracoscopic sympathectomy for control of
recurrent ventricular tachycardia in patients mainly with Chagas
disease.
Abstract
Introduction: The autonomous system plays an important role as a trigger
of cardiac arrhythmias. Cardiac sympathetic denervation (CSD) achieved
by stellate and proximal thoracic ganglia resection has been reported as
an alternative approach for the management of ventricular arrhythmias
(VA) in structural heart disease (SHD) patients. Insufficient data
regarding Chagas Disease (ChD) is available. Methods: Patients who
underwent CSD for better management of ventricular arrhythmias (VA) in
SHD, mainly ChD, in a single tertiary center in Brazil were evaluated
for safety and efficacy outcomes. Results: Between June 2014 and March
2020, fourteen patients (age 59±7.5, 85% male, mean ejection fraction
30.5±7.9%) were submitted to left or bilateral CSD. In a median
follow-up time of 143 (Q1: 30; Q3: 374) days, eight patients (57,2%)
presented VT recurrence. A significant reduction in the median burden of
ventricular arrhythmias comparing six months before and after procedure
(10 to 0; p=0.004). For the nine ChD patients, the median burden of
appropriate therapies was also reduced (11 to 0; p=0.008). There were
two cases of clinically relevant pneumothorax and three cases of
transient hemodynamic instability, but no direct procedure-related
deaths occurred. Additionally, there was no long-term adverse events,
Conclusion: CSD is safe and seems to be effective in reducing the burden
of VT/VT storm in SHD patients, including ChD patients. Randomized
trials are needed to clarify its role in the management of these
patients.