Bilateral Cardiac Sympathetic Denervation for the Management of Electrical Storm

Compared with asystole and pulseless electrical activity, VT and ventricular fibrillation are less frequent modes of sudden cardiac death in patients after cardiac transplantation (7), because these hearts are completely denervated. Patient # Age (yrs)/Sex Substrate/LVEF VT Type Antiarrhythmic Agents GA/TEA VT RFA Arrhythmia Episodes/Arrhythmia Therapies* Response to BCSD Survival to Discharge Intermediate Follow-Up (Days After Discharge) Before BCSD After BCSD 1 69/M Sarcoid/20% MMVT Carvedilol, amiodarone No/No 2 endo 45/30(14days) 3/2(6days) Partial Yes Death, CHF (89days) 2 66/F NICM/20% PMVT Amiodarone, lidocaine, metoprolol Yes/Yes NA 51/6(13days) 27/2(8days) Poor No NA 3 55/M NICM/20% MMVT Amiodarone, carvedilol, lidocaine, mexiletine No/No 2 endo, 1 epi 39/17(9days) 0/0(3days) Complete Yes Alive (207days) 4 47/M NICM/15% MMVT Amiodarone, esmolol, diltiazem, carvedilol, verapamil, lidocaine, procainamide Yes/Yes 3 endo 87/11(28days) 0/0(7days) Complete Yes Alive (153days) 5 49/M NICM/40% MMVT Amiodarone, metoprolol No/No 1 endo, 1 epi 43/25(15days) 0/0(14days) Complete Yes Alive (129days) 6 75/M ARVC/40% MMVT Amiodarone, metoprolol No/No 2 endo, 1 epi 36/36(14days) 0/0(14days) Complete Yes Death, unknown cause (21days) Table 1 Baseline Characteristics, Arrhythmia Burden, Clinical Management, and Acute and Intermediate Outcomes ARVC = arrhythmogenic right ventricular cardiomyopathy; BCSD = bilateral cardiac sympathetic denervation; CHF = congestive heart failure; endo = endocardial; epi = epicardial; F = female; GA = general anesthesia; LVEF = left ventricular ejection fraction; M = male; MMVT = monomorphic ventricular tachycardia; NA = not applicable; NICM = nonischemic cardiomyopathy; PMVT = polymorphic ventricular tachycardia; RFA = radiofrequency ablation; TEA = thoracic epidural anesthesia; VT = ventricular tachycardia.