A case of dilated cardiomyopathy successfully managing refractory electrical storm through sympathetic modulation

Q4 Medicine

Journal of Cardiology Cases Pub Date : 2025-03-01 DOI:10.1016/j.jccase.2024.11.008

Phuong Ngo Thanh Nguyen MD , Akiko Ueda MD , Yumi Katsume MD , Noriko Nonoguchi MD , Takato Mohri MD , Yoshifumi Hirata MD , Haruhiko Kondo MD , Kunitaro Watanabe MD , Kyoko Soejima MD

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Abstract

Recent research has demonstrated the effectiveness of cardiac sympathetic denervation in treating ventricular arrhythmias. We present a patient with dilated cardiomyopathy characterized by ventricular tachycardia (VT) resistant to standard treatments. Repeated left-sided stellate ganglion blocks provided temporary relief, followed by a thoracoscopic sympathectomy with T2–4 ganglionectomy, which significantly reduced the burden of VT. This intervention also allowed for the gradual reduction of antiarrhythmics. During the course of the hospital stay, the patient's activities of daily living steadily improved. Approximately one month following the surgical surgery, the patient was successfully discharged with a reduced burden of VT.

Learning objective

Evaluate the efficacy of cardiac sympathetic denervation (CSD) and ganglionectomy in treating refractory ventricular tachycardia in patients with dilated cardiomyopathy. Identify the potential advantages of CSD and ganglionectomy in avoiding the necessity for therapeutic escalation in refractory ventricular tachycardia cases.

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扩张型心肌病通过交感神经调节成功治疗难治性电风暴1例

最近的研究证实了心脏交感神经去支配治疗室性心律失常的有效性。我们提出了一个扩张型心肌病的特点是室性心动过速（VT）抵抗标准治疗。反复的左侧星状神经节阻滞提供了暂时的缓解，随后进行胸腔镜交感神经切除和T2-4神经节切除术，这显著减轻了VT的负担。这种干预也允许逐渐减少抗心律失常药物。在住院期间，患者的日常生活活动能力稳步改善。手术后约1个月，患者顺利出院，减轻了vt负担。学习目的评价心脏交感神经断神经（CSD）和神经节切除术治疗扩张型心肌病难治性室性心动过速的疗效。确定CSD和神经节切除术在避免难治性室性心动过速病例治疗升级方面的潜在优势。

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