Introduction
The intracardiac cardioverter-defibrillator (ICD) is shown to play an
important role in preventing sudden cardiac death (SCD) in patients with
structural heart disease (1). However, ICD shocksare associated with
significant increase in morbidity and also have a negative impact on
quality of life (2,3). Thus, every effort needs to be taken to reduce
the incidence of ICD shocks without affecting their efficacy. The
autonomic nervous system has a very important role in genesis and
maintenance of cardiac arrhythmias, especially ventricular tachycardia
VT (4,5). Cardiac sympathetic denervation (CSD) is thus, an interesting
therapeutic option in many patients with VT when they are non-responsive
to standard treatment. Though it’s role is established in managing
hereditary channelopathies like long QT syndrome and catecholaminergic
VT, an increasing volume of recent literature is consolidating its role
as a viable therapeutic option in the management of refractory VT (6-10)
in structural heart disease. The mechanism underlying the benefit of CSD
in VT is by reducing the dispersion of myocardial repolarization and
increasing the threshold of VT inducibility, as studied in animal models
of myocardial infarction (11,12). There are only few studies assessing
the long term efficacy of CSD in patients with refractory VT or VT storm
(13,14). In the current article we aim to describe a relatively large
single centre experience of long term effect of CSD in patients with
refractory VT or VT storm.