David R Okada1, Fabrizio R Assis1, Nisha A Gilotra1, Jinny S Ha2, Ronald D Berger1, Hugh Calkins1, Jonathan Chrispin1, Kaushik Mandal2, Harikrishna Tandri3. 1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: htandri@jhmi.edu.
Abstract
BACKGROUND: Ventricular arrhythmias (VAs) in cardiac sarcoidosis (CS) are frequently refractory to both antiarrhythmic drug (AAD) therapy and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter-defibrillator (ICD) shocks in patients with nonischemic cardiomyopathy. OBJECTIVE: We aimed to report our center's preliminary experience with CSD in patients with known or presumed CS and refractory VAs. METHODS: Patients with CS and refractory VAs 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 years; 2 men [40%]; mean left ventricular ejection fraction 38% ± 11%) underwent CSD for VA refractory to AAD therapy and CA. Four of 5 patients underwent bilateral CSD; 1 patient underwent right-sided sympathectomy only because of poor intraoperative 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 a 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; both underwent repeat CA. In addition, 1 patient required cardiac transplantation for progressive heart failure. CONCLUSION: CSD may be a feasible therapeutic adjunct for patients with CS and VA refractory to AAD therapy and CA.
BACKGROUND:Ventricular arrhythmias (VAs) in cardiac sarcoidosis (CS) are frequently refractory to both antiarrhythmic drug (AAD) therapy and catheter ablation (CA). Cardiac sympathetic denervation (CSD) has been shown to reduce VA burden and implantable cardioverter-defibrillator (ICD) shocks in patients with nonischemic cardiomyopathy. OBJECTIVE: We aimed to report our center's preliminary experience with CSD in patients with known or presumed CS and refractory VAs. METHODS:Patients with CS and refractory VAs 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 years; 2 men [40%]; mean left ventricular ejection fraction 38% ± 11%) underwent CSD for VA refractory to AAD therapy and CA. Four of 5 patients underwent bilateral CSD; 1 patient underwent right-sided sympathectomy only because of poor intraoperative 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 a 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; both underwent repeat CA. In addition, 1 patient required cardiac transplantation for progressive heart failure. CONCLUSION: CSD may be a feasible therapeutic adjunct for patients with CS and VA refractory to AAD therapy and CA.
Authors: Nisha A Gilotra; Jan M Griffin; Noelle Pavlovic; Brian A Houston; Jessica Chasler; Colleen Goetz; Jonathan Chrispin; Michelle Sharp; Edward K Kasper; Edward S Chen; Ron Blankstein; Leslie T Cooper; Emer Joyce; Farooq H Sheikh Journal: J Card Fail Date: 2021-07-11 Impact factor: 5.712