To the Editor: The sympathetic nervous system plays an important role in ventricular arrhythmogenesis. Left cardiac sympathetic denervation (LCSD) decreases the incidence of ventricular arrhythmias (VAs) and sudden cardiac death in patients with severe VAs (1, 2). However, when LCSD is ineffective in suppressing VAs, adjunctive right cardiac sympathetic denervation may be an option. In humans, the safety and feasibility of bilateral cardiac sympathetic denervation (BCSD) in the management of VAs remains unclear. The present study was undertaken to assess the benefit of BCSD for the acute management of persistent VAs. We reviewed the records of patients who underwent BCSD (or right cardiac sympathetic denervation after prior LCSD failed to control arrhythmias). Review of patient data was in accordance with the guidelines of the institutional review board. These patients presented with electrical storm characterized by incessant ventricular tachycardia (VT) or repeated episodes of ventricular fibrillation.

Five men and 1 woman were included in the study. The mean age was 60.1 years (range: 47 to 75 years), and the mean left ventricular ejection fraction was 25.8%(range: 15% to 40%)(Table 1). Five patients presented with monomorphic VT (MMVT), and 1 patient had polymorphic VT. Of patients with MMVT, 4 had undergone previous endocardial VT ablation, and 2 had undergone epicardial VT ablation. The arrhythmia burden and number of therapies (automated or external defibrillator shocks and antitachycardia pacing episodes) experienced by each patient are shown in Table 1.