Abstract 16805: Renal Sympathetic Denervation as an Adjunctive Therapy to Radiofrequency Ablation and Cardiac Sympathetic Denervation for Refractory Ventricular Tachycardia

Introduction: The autonomic nervous system plays an important role in initiating and perpetuating ventricular arrhythmias. Neuromodulation procedures aimed at reducing sympathetic outflow to the heart, such as cardiac sympathetic denervation (CSD), can successfully treat many patients with refractory ventricular tachycardia (VT). It is unknown if there is benefit in performing CSD in combination with renal sympathetic denervation (RSD) to treat refractory VT. Hypothesis: When used in combination with CSD and catheter ablation, RSD reduces ICD therapy burden in patients with refractory VT. Methods: We reviewed adult patients who underwent RSD at UCLA Ronald Reagan Medical Center after presenting with refractory VT despite having received ablation(s) and, in all but one case, CSD. We evaluated the ICD therapy burden 1 month pre-RSD to monthly ICD therapies over the 6 month period post-RSD. Results: We performed RSD on 10 patients (mean age=62±10 years,90% male). Nine (90%) had NICM. Mean LVEF was 33±10%. All had prior catheter ablations for VT (median 2 ablations). Of the 9 patients who underwent RSD after CSD, 3 (33%) had both performed during the same hospitalization, of whom 1 died during the hospitalization due to uncontrollable VT. Median follow up was 6.5 months. No further deaths occurred during follow-up. The number of ICD therapies decreased significantly after RSD (total monthly VT episodes pre-RSD was median 11 (IQR 6-23) vs. post-RSD 0.33 (IQR 0-3), p=0.004; monthly ICD shocks pre-RSD was median 5 (IQR 1.5-8) vs. post-RSD 0 (IQR 0-1), p=0.004). Two patients (20%) had complete suppression of VT episodes post-RSD and 6 (60%) had over 75% reduction in VT episodes (Fig. 1). Conclusions: We found that RSD was often performed as an adjunctive treatment for patients presenting with refractory VT after catheter ablation and CSD. As hypothesized, RSD in conjunction with CSD significantly reduced the number of VT episodes and ICD shocks over the 6 months following the procedure.