Po-04-233 multidisciplinary approaches to treat ventricular arrhythmias with radioablation and cardiac sympathectomy (maverics)

Ventricular arrhythmias (VAs) are the most lethal arrhythmias. Established therapies to prevent occurrence of VAs include anti-arrhythmic drugs (AADs) and catheter ablation (CA). For patients with recurrent VAs despite AADs and CA, there exist novel treatment modalities such as cardiac sympathetic denervation (CSD) via percutaneous and surgical approach and stereotactic body radiation therapy (SBRT). The current study reports the outcomes of CSD and SBRT from a tertiary care academic center. To report outcomes of CSD and SBRT for treatment of VAs refractory to conventional treatment with AADs and CA. Study comprises all patients undergoing CSD or SBRT at our center from 10/2018 to 10/2021. Patients with less than 2 months of available follow-up data were excluded. Retrospective chart review was performed to collate data for demographics, clinical characteristics, arrhythmia burden before and after novel therapies (maximum 12 months), and complications during study period. Burden of VAs in the form of episodes of anti-tachycardia pacing (ATP) and defibrillator shocks per month were assessed as primary efficacy outcome. Complications during CSD and SBRT were assessed as primary safety outcome. Overall, 25 patients underwent novel therapies for VAs. Thirteen were excluded due to insufficient follow up data. Of 12 included patients, a total of 4, 5, and 3 patients underwent SBRT, CSD, and both CSD/SBRT, respectively. Median age of the study population was 66 years (55-72). The majority of the patients (10/12) were male. Median left ventricular ejection fraction was 30% (25%-34%). Eight patients had non-ischemic cardiomyopathy. Median number of AADs and CA prior to novel therapies was 3 (2-5) and 1 (0-2), respectively. Follow up was available for a median of 12 (12-12) months before and 12 (9-12) months after intervention. Overall, 11 of 12 patients demonstrated a reduction in VA burden. Mean number of ATP and shock episodes was significantly lower after novel therapies (39±43 vs 3±6; p= 0.008). No procedure-related complications were observed during the study period. Incorporation of novel VA treatment modalities is associated with a reduced arrhythmia burden in this single center study. Further studies are warranted to validate these findings.