Abstract 13956: Multidisciplinary Approaches to Treat Ventricular Arrhythmias With Radioablation and Cardiac Sympathectomy (MAVERICS)

Abstract

Background: Ventricular arrhythmias (VAs) are the most lethal arrhythmias. Established therapies to prevent VAs include anti-arrhythmic drugs (AADs) and catheter ablation (CA). For patients with recurrent VAs despite AADs and CA, novel therapies such as cardiac sympathetic denervation (CSD) and stereotactic body radiation therapy (SBRT) exist. This study reports outcomes of CSD and SBRT at a tertiary care academic center. Methods: Study comprises all patients undergoing CSD or SBRT at one center from 10/2018 - 10/2021. Patients with less than 2 months of follow-up were excluded. Retrospective chart review was performed to collate data for demographics, clinical characteristics, arrhythmia burden before and after novel therapies (maximum 12 months), and treatment complications. VA burden in the form of anti-tachycardia pacing (ATP) episodes and defibrillator shocks was assessed as primary efficacy outcome. Treatment complications were assessed as primary safety outcome. Results: Overall, 25 patients underwent novel therapies for VAs, and 13 were excluded for insufficient follow up. Five, 4, and 3 patients underwent CSD, SBRT, and both, respectively. Median age was 66 years (55-72), and 10 (83%) were male. Median left ventricular ejection fraction was 30% (25%-34%). Four patients (33%) had ischemic cardiomyopathy. Median number of AADs and CA prior to novel therapies was 3 (2-5) and 1 (0-2), respectively. Follow up was available for a median of 12 (12-12) months before and 12 (9-12) months after treatment. Overall, VA burden was reduced in 11 of 12 patients (Figure 1). Mean number of ATP and shock episodes was significantly lower after novel therapies (39±43 vs 3±6; p= 0.008). No procedure-related complications were observed. Conclusion: Novel VA treatment modalities are associated with a significantly reduced arrhythmia burden in this single center study. There is a promising role of these therapies as an adjunct to the existing treatment modalities of CA and AADs.