Abstract
［Objective］ Cardiac sympathetic denervation（CSD）is an important strategy in managing refractory ventricular tachycardia（VT）. The original CSD procedure consist of the sympathectomy of the lower half of the stellate ganglion（SG）and T2-T4. Simplifying the existing CSD procedure to minimize surgical invasion without compromising success may be the key to further expanding its clinical application. We performed endoscopic bilateral sympathectomy T2-4 or 5（T2-4 or 5 BCSD）with SG-sparing to reduce surgical invasion because the removal of the SG has the potential to cause Horner syndrome and injury to the brachial plexus, subclavian artery and vein. This study aimed to assess T2-4 or 5 BCSD for untreatable VT. ［Methods］ We enrolled HFrEF patients with VT refractory to multidisciplinary approaches, including catheter ablation. Patient characteristics, procedural outcomes and number of arrhythmic events were evaluated. ［Results］ Five patients with HFrEF（EF 27±10％）underwent T2-4 or 5 BCSD for treatment-resistant VT（VT storm 3, repetitive VT requiring ICD therapy 2）. The CSD procedure was successfully performed without procedure-related complications（mean operative duration 108±24 minutes）. T2-4 or 5 BCSD was effective for suppressing VT in 3 patients. The mean median number of ICD shocks before CSD was 10（range 6-31）and decreased to 0 during available follow-up after CSD. Otherwise, T2-4 or 5 BCSD was ineffective for suppressing VT in 2 patients, while additional BCSD of the lower half of the SG and T5 was effective in preventing VT storm in 1 patient. ［Conclusions］ A T2-4 or 5 BCSD with SG-sparing is a feasible, safe and effective treatment for suppressing refractory VT in HFrEF patients. In some patients, however, removal of the SG is required.
