PO-698-06 NEUROMODULATION FOR THE TREATMENT OF REFRACTORY VENTRICULAR ARRHYTHMIAS

Abstract

Neuromodulation of sympathetic tone is increasingly recognized as a therapeutic strategy for patients with refractory ventricular arrhythmias (VA). Percutaneous stellate ganglion blockade (SGB), transcutaneous magnetic stimulation (TcMS), and surgical sympathetic denervation (SD) have all been utilized in this setting. To describe our experience with autonomic neuromodulation for the treatment of refractory VA. This retrospective cohort study included all patients at the Hospital of the University of Pennsylvania with antiarrhythmic drug (AAD) refractory VA from 2019-2021 who were treated with SGB, TcMS, or SD. A total of 33 patients (age 60±14 years, 25 (76%) male, 14 (42%) polymorphic VA) met inclusion criteria. VA were refractory to 1.8±0.8 AAD. SGB was performed on 11 patients (33%), TcMS on 19 (56%), and SD on 6 (18%). Two patients underwent both SGB and SD, and one patient underwent both SGB and TcMS. Two patients who underwent SGB had the procedure repeated after 1 and 5 days respectively due to recurrent VA. SGB was performed on the left-side in 5 (46%) and was bilateral in 6 (54%) patients. SGB was guided by ultrasound in 9 (82%), fluoroscopy in 3 (27%), or anatomic landmarks with no imaging in 1 (9%). Lidocaine was the most common agent used (n=9). SD was performed on the left-side in 1 (17%) and was bilateral in 5 (83%). SD was performed via thoracotomy in 1 (17%) due to body habitus and via video-assisted thoracoscopic surgery in 5 (83%). There were no complications of any neuromodulation approach. Neuromodulation was associated with a reduction in the number of episodes of sustained VA from 10.4±11.3 episodes in the 24-hours prior to the initial neuromodulation strategy to 1.3±3.1 episodes in the subsequent 24-hours (p<0.001) with no decrease in 5 patients (15%). During 602±250 days of follow-up, 18 (55%) experienced recurrent ventricular arrhythmias and among those patients, the time to recurrence was 22±44 days. Recurrence was similar in patient in monomorphic (58%) vs polymorphic VA (50%). Autonomic neuromodulation with SGB, TcMS, or SD in patients with AAD refractory VT is safe and results in substantial acute reduction of VA burden in the majority although recurrent arrhythmias are common and not all patients experience a reduction in arrhythmia burden.