PO-713-02 BILATERAL SYMPATHECTOMY FOR TREATMENT OF REFRACTORY MULTIFOCAL PREMATURE VENTRICULAR CONTRACTIONS

Abstract

Bilateral sympathectomy (BS) for refractory life-threatening ventricular arrhythmias is a neuromodulatory intervention targeting sympathetically driven focal or reentrant ventricular arrhythmias. Our objective is to provide a more complete and successful option for intervention in patients in whom PVC ablation is not feasible or has been unsuccessful. 28 patients with >5% PVC burden and concomitant nonischemic cardiomyopathy (NICM) who previously failed medical and ablation therapy were referred for BS. All patients underwent bilateral video-assisted thoracoscopic surgical approach with T1-T4 sympathectomy. Primary efficacy endpoints were-1) Postprocedural PVC burden resolution; 2) Improvement in EF, and 3) Antiarrhythmic drugs (AAD) cessation. Safety endpoints included peri-/post-procedural complication. A total of 28 NICM patients (with 46.4% also experiencing episodes of VF/VT) were included. Prior to BS, 89.2% patients had >5 PVC morphologies, 7.1% 4-5, and 3.6% had 1-3. There was significant reduction in PVC post BS (1.3+1.1% vs. 23.7+9.9% pre-BS, p<0.001). There was a significant improvement in EF (46.3+9.5% vs. 35.5+6.1% pre-BS; p < 0.001) and reduction in AAD post BS (0.1+0.3 vs. 2.9+0.2 pre-BS; p<0.001). 7.1% patients had minor complications (ptosis, small pneumothorax) while 10.7% had experienced major complications: repeated post VF (stabilized POD#2, hemothorax requiring ligation, and chylothorax requiring ligation). BS for refractory PVCs significantly improved PVC burden, EF, and AAD cessation in patients with multifocal PVC’s who failed prior medical/ablative therapies.