During a period of three years, from 2015 through 2017, twenty patients (
N = 20) failed traditional medical and interventional treatment for the management of ventricular arrhythmias and electrical storms. After remaining refractory, the patients were referred to our thoracic surgery department for a VATS based treatment. The patients all had ventricular arrhythmias and electrical storms secondary to different cardiomyopathies. All were refractory to combined medical-beta-blocker therapy (primarily amiodarone), implanted cardioverter defibrillation (ICD) and ablation therapy. The inclusion criteria for considering VATS denervation in these patients included ventricular arrhythmias refractory to combined pharmacological (beta-blocker), ablation and ICD therapy, and patients presenting with electrical storms defined as three or more registered ICD shocks within a 24-h period. All twenty (
N = 20) patients agreed to surgery and were taken to cardiac denervation using a bilateral VATS approach by two thoracic surgeons at a single Cardiothoracic center. Of these 20 patients (14 men and 6 women) ages 20 to 73 years (average 56.7 years), nine (
N = 9) had VAs secondary to Chagas disease, seven (
N = 7) patients secondary to chronic ischemic cardiomyopathy, three (
N = 3) patients had VAs secondary to dilated cardiomyopathy and one (
N = 1) patient had VAs secondary to long-QT syndrome. Fifteen (
N = 15) patients registered sustained ventricular tachycardias (VT), three (
N = 3) patients registered ventricular fibrillations (VF), two (
N = 2) patients registered mixed VT/VFs and six (
N = 6) patients had electrical storms. All twenty (
N = 20) patients had beta-blocker (amiodarone) therapy, six (
N = 6) had pacemakers and nineteen (
N = 19) had Implanted Cardioverter defibrillators (ICDs). Of the twelve (
N = 12) patients having had previous ablation therapy, 92% (
N = 11) had ICDs. Patient comorbidities included arterial hypertension primarily and six (
N = 6) were on the heart transplant waiting list. A summary of patient characteristics is detailed in Table
1. The patients presenting with VAs secondary to Chagas disease all had their Trypanosoma cruzi treated with anti-protozoan therapy, however their resulting cardiomyopathy progressed to refractory VAs.
Table 1
Patient Characteristics and Results