Abstract 16167: Stellate Ganglion Blockade and Bilateral Cardiac Sympathetic Denervation in Patients With Life-Threatening Ventricular Arrhythmias

Introduction: Autonomic modulation is an increasingly recognized strategy to treat ventricular tachycardia (VT) or ventricular fibrillation (VF) refractory to beta-blockers, antiarrhythmic drugs and catheter-based ablation procedures. The purpose of this study was to report our experience with bilateral cardiac sympathetic denervation (CSD) and stellate ganglion blockade (SGB) in the management of life-threatening ventricular arrhythmias. Methods and Results: Clinical data of five patients who underwent bilateral CSD and/or SGB to control refractory VT/VF were reviewed (Table). Patients did not require or were poor candidates for heart transplantation. Beta-blockade therapy was held in patients B, C and D due to hypotension or shock; calcium-channel blockers and nitrates were preferred in patients with coronary artery spasm (cases A and E). We attempted catheter-based ablation of VT in patients B and C. All patients underwent SGB that temporarily suppressed their symptoms. We performed bilateral CSD in patients A and E that provided long-term resolution of symptoms. No major procedural complications occurred after SBG or CSD. We implanted an implantable cardioverter-defibrillator (ICD) in patient E and prescribed a wearable-cardioverter defibrillator on patient A for four weeks, but an ICD was not implanted. Hemodynamic instability precluded CSD on three patients. Despite temporary suppressing the arrhythmia burden with SGB on patients B and D, they eventually died of septic shock or multi-organ failure. Patient C died of VT storm refractory to antiarrhythmics, VT ablation and cardiac sympathetic modulation. Conclusions: The cardiac sympathetic nerves are important targets in the management of ventricular arrhythmias. SGB and CSD are effective procedures that suppress VT/VF burden and they can be offered to patients with refractory ventricular arrhythmias as an adjunct option to conventional therapy.