Is stellate ganglion resection really necessary for cardiac sympathetic denervation?

INTRODUCTION: An electrical storm (ES) is characterized by electrical instability and the recurrence of clustered ventricular arrhythmias (VAs). The current definition according to the latest European Society of Cardiology (ESC) guidelines is the occurrence of sustained VAs three or more times within 24 h requiring intervention, with each event separated by at least 5 min management often requires an implantable cardioverter-defibrirallator (ICD), pharmacologic therapy, catheter ablation, and modulations of the autonomic nervous system. Permanent cardiac sympathetic denervation (CSD) can be considered a valid option when resolving cannot be achieved in persistent cases.
METHODS: This study comprises a retrospective series of 7 patients experiencing ES who underwent CSD at our medical facility, spanning from December 2019 to May 2023. Patients’ age, sex, left ventricular ejection fraction (%), New York Heart Association class, operation side, number of ports, operation time, and length of hospital stay were recorded.
RESULTS: The mean age of the patients was 52±18 years, with male patients being the majority (71.4%). All patients were followed up for a mean of 473±455 days. There was no mortality associated with the surgical procedure, and our morbidity was a prolonged air leak lasting 10 days in one patient. We observed only one case of ES related to an ICD shock occurring once at 6 months postoperatively.
DISCUSSION AND CONCLUSION: Considering the possible serious complications, our modification may be perceived as an easy-to-use technique for treating VAs. Large, multicenter studies are needed for validation.