Cardiac Sympathetic Denervation for Termination of Ventricular Tachycardia Storm: A Multidisciplinary Case

Abstract

Background: Ventricular tachycardia (VT) storm is a life-threatening arrhythmic emergency. In recent years, autonomic neuromodulation has emerged as an adjunctive strategy beyond catheter ablation, antiarrhythmic drugs, and sedation.

Case summary: A 39-year-old man with dilated cardiomyopathy and recurrent VT storm despite implantable cardioverter-defibrillator implantation, multiple ablation procedures, and long-term amiodarone therapy was admitted with incessant VT. Combined endocardial-epicardial ablation failed to provide durable control. Refractory VT recurred postprocedure and was suppressed under deep sedation but recurred upon sedation weaning. Sequential left stellate ganglion blockage (LSGB) and bilateral thoracoscopic cardiac sympathetic denervation (CSD) successfully terminated the storm, providing arrhythmia-free survival for 1 year until recurrence, after which he ultimately underwent orthotopic heart transplantation.

Discussion: This case highlights the efficacy of CSD as a rescue therapy in refractory VT storm associated with structural heart disease. Suppression of VT using LSGB may predict a favorable response to CSD.

Take-home messages: Autonomic neuromodulation, including CSD, is an adjunctive therapeutic approach for VT storm, offering sustained sympathetic suppression and VT control. Patients who demonstrate good VT suppression with LSGB, suggesting a predominant sympathetic contribution, may be favorable candidates for CSD.

Keywords: cardiac sympathetic denervation; catheter ablation; dilated cardiomyopathy; implantable cardioverter-defibrillator; ventricular tachycardia storm.