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Video assisted thoracoscopic sympathectomy for intractable recurrent VT after minimal‐invasive LVAD implantation
Author(s) -
Salewski Christoph,
Nemeth Attila,
Sandoval Boburg Rodrigo,
Steger Volker,
Krüger Tobias,
Schreieck Jürgen,
Schlensak Christian,
Popov AronFrederik
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14639
Subject(s) - medicine , sympathectomy , implantable cardioverter defibrillator , ventricular assist device , ablation , surgery , cardiology , ventricular tachycardia , catheter ablation , catheter , heart failure
Background Recurrent ventricular tachycardia (VT) can occur after left ventricular assist device (LVAD) implantation. In this case, medical treatment might be insufficient. We report a case of a left‐sided thoracoscopic sympathectomy as a feasible treatment escalation in intractable VT. Case Report A 72‐year‐old patient underwent an internal cardioverter defibrillator (ICD) implantation as primary prophylaxis for VTs in the setting of staged heart failure therapy. Afterwards, due to a progressive dilative cardiomyopathy he underwent a minimal‐invasive LVAD implantation (HeartWare, Medtronic). After an uneventful minimal‐invasive LVAD‐implantation the patient was discharged to a rehabilitation program. However, after 7 weeks he developed recurrent VTs which were successfully terminated by ICD shocks deliveries leading to severe discomfort and frequent hospitalizations. Eventually, the patient was admitted with an electrical VT storm. Successful endocardial catheter ablation of all inducible VTs were performed combined with multiple rearrangements of his oral antiarrhythmic medication. However, all these treatments could not suppress further occurrence of VTs. After an interdisciplinary discussion the patient agreed to a left‐sided video‐assisted thoracoscopic sympathectomy. After a follow up of 150 days the patient was free from VTs apart from one short event. Conclusion We believe video‐assisted thoracoscopic sympathectomy might be a surgical treatment option in patients with intractable recurrent VTs after catheter ablation of VT reentrant substrate even after minimal‐invasive LVAD implantation.