PO-05-036 PERCUTANEOUS STELLATE GANGLIA ABLATION IN THE MANAGEMENT OF VTSTORM

Abstract

VT storm is a clinical emergency associated with high mortality. Neural modulation of the cardiac sympathetic chain, usually in the form of surgical sympathectomy, has shown to be effective in achieving reduction in appropriate ICD shocks and VT episodes. We hypothesised Percutaneous Stellate Ganglion Ablation (SGA) is a safe and effective alternative modality of neuromodulation in patients with VT storm. Patients with ES refractory to standard management, including sedation and mechanical ventilation, antiarrhythmic agents and beta-blockers, underwent bilateral percutaneous SGA. The ablation was performed at 2 levels - C7 and T1, bilaterally, under fluoroscopic guidance using a customized protocol. (Figure) At each site, 3 lesions were delivered sequentially at 50, 55 and 60 deg. C for 90 seconds using a COSMAN RF generator and RF needle electrode of 5cm length and 4mm active tip with ipsilateral Horner’s syndrome being the clinical end-point for successful ablation. Patients were followed up till discharge and as outpatients with periodic device interrogation There were 6 patients with refractory VT storm (4 male & 2 female) with a mean age of 56.5±5.2 years. The VT was monomorphic in 4 and polymorphic in the other 2 patients. The substrate was Ischaemic cardiomyopathy in 2, Non-ischaemic cardiomyopathy in 3 and Hypertrophic cardiomyopathy in 1 patient. The meean LVEF was 35 ± 20%. There were no periprocedural complications. Post-procedure, 2 out of the 6 patients had one episode of Non-sustained VT each in-hospital. All patients were discharged on Amiodarone and Metoprolol. The mean follow-up duration was 15± 3 months. At last follow-up all of them are alive and none of then received any shocks.. One patient had a VT at 42 days after procedUre which was terminated by device using ATP. SGA by RFA is a safe, effective, inexpensive, well-tolerated and minimally invasive procedure for neuromodulation and should be considered in drug refractory ES.