Left-sided sympathetic ganglion block for ventricular tachycardia in patients with LVAD
E Simsek, Y Tepeli, B O Horosanli, A Urganci, A Candemir, E I Yetkin, M Uyar, U Kahraman, C Engin, T Yagdi, M Ozbaran, C Eyigor, S NalbantgilAbstract
Background/Introduction
Recurrent ventricular tachycardia (VT) in patients supported with left ventricular assist devices (LVADs) is associated with shocks, heart failure decompensation and mortality. Sympathetic modulation with left-sided sympathetic ganglion block (LSGB) has emerged as a potential adjunctive strategy, but data in LVAD recipients are limited.
Purpose
To describe the safety and clinical impact of LSGB on VT recurrence in LVAD patients with VT episodes.
Methods
We retrospectively analysed consecutive LVAD recipients who experienced recurrent ICD shocks for VT or VF and underwent LSGB in our centre. Baseline characteristics (etiology, right ventricular function, atrial fibrillation, antiarrhythmic therapy, device type) and LVAD support time were collected. All patients carried an implantable cardioverter-defibrillator or cardiac resynchronisation therapy device and were treated with beta-blockers and other antiarrhythmics (amiodarone and/or mexiletine). LSGB with radiofrequency was performed on the left side in all cases (figure 1A and B). Patients were followed for VT recurrence, particularly beyond the first week after LSGB, and for vital status and transplantation. Procedural complications, including neurological sequelae, were systematically recorded.
Results
Nine LVAD patients were included (89% non-ischaemic cardiomyopathy, 78% male, median age 46 years [range 28–66]). Median LVAD support time at LSGB was 3 years (range 1–11). Atrial fibrillation was present in 44%, and 55% had moderately depressed right ventricular function. During a median follow-up of 8 months (range 1–35), 44% of patients had no VT recurrence at any time after LSGB. After the first week, 77% remained free from further VT episodes. Overall, 22%(2) of patients died and 11% (1) underwent heart transplantation during follow-up.(Table1) No permanent procedure-related complications occurred; transient ipsilateral ptosis was observed in all patients and resolved spontaneously.
Conclusion(s)
In this small series of LVAD recipients with VT, LSGB was feasible and appeared to reduce VT recurrence, particularly beyond the first week after the procedure, with an acceptable safety profile. LSGB may represent a useful adjunct to conventional antiarrhythmic therapy in selected LVAD patients with VT, warranting confirmation in larger prospective cohorts.Table 1