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Cardiac Sympathectomy For Refractory Ventricular Arrhythmias in Cardiac Sarcoidosis.


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Cardiac Sympathectomy For Refractory Ventricular Arrhythmias in Cardiac Sarcoidosis.

Heart Rhythm. 2019 Feb 25;:

Authors: Okada DR, Assis FR, Gilotra NA, Ha JS, Berger RD, Calkins H, Chrispin J, Mandal K, Tandri H

Abstract
BACKGROUND: Ventricular arrhythmias (VA) in cardiac sarcoidosis (CS) are frequently refractory to both anti-arrhythmic drug therapy (AAD) and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter- defibrillator (ICD) shocks in patients with non-ischemic cardiomyopathy.
OBJECTIVE: We aimed to report our center’s preliminary experience with CSD in patients with known or presumed CS and refractory VA.
METHODS: Patients with CS and refractory VA who underwent CSD at our institution were included. Patient characteristics, procedural outcomes, and number of arrhythmic events including ICD shocks pre- and post- CSD are reported.
RESULTS: Five patients with CS (mean age 53 ± 11 yrs; 40% male; mean LVEF 38 ± 11%) underwent CSD for VA refractory to AAD and CA. Four of 5 patients underwent bilateral CSD; 1 patient underwent right-sided sympathectomy only due to poor intra-operative visualization on the left. Procedural complications included hemothorax in 1 patient and azygous vein injury in 1 patient. The median number of ICD shocks in the 6 months pre-CSD was 5. During median follow- up of 26 months (range 5- 29 months), the median number of ICD shocks post-CSD was 0; 1 patient had sustained VA that was below the threshold for device therapy, and 1 patient had symptomatic premature ventricular contractions (PVC); both underwent repeat CA. In addition, 1 patient required cardiac transplantation for progressive heart failure.
CONCLUSIONS: CSD may be a feasible therapeutic adjunct for patients with CS and VA refractory to AAD and CA.

PMID: 30818090 [PubMed – as supplied by publisher]

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