Introduction:
Sudden cardiac death is thought to be
caused by ventricular arrhythmias in 75% to 80% of cases, resulting in
184,000 to 450,000 deaths in the United States per year [1].
Ventricular arrhythmias are most commonly due to myocardial infarction
or cardiomyopathy. Genetic Syndromes such as Brugada Syndrome or
catecholaminergic-related polymorphic ventricular tachycardia (CRPVT),
are common causes of ventricular arrhythmias but these typically occur
in younger patients [2]. An electrical storm (ES) is defined as at
least three episodes of ventricular arrhythmias including ventricular
tachycardia (VT) or ventricular fibrillation (VF) in 24 hours,
significantly increasing risk of heart failure and mortality. An ECMO
circuit uses a modified cardiopulmonary machine to support patients and
allow time for their cardiac and/or pulmonary function to improve. In
instances of refractory ES, case studies have shown that ECMO support
can be utilized as a bridge to therapy [3].
Multiple treatments for ES have been proposed, including sympathetic
blockade with beta-blockers (BB), anti-arrhythmics, and catheter
ablation but due to drug resistance and refractory arrhythmias, other
methods have been proposed. Stellate ganglion blockade (SGB), and
Cardiac Sympathetic Denervation (CSD) have been attempted in instances
of medically refractory ES [4]. We present a patient with Brugada
Syndrome and refractory ventricular arrhythmia on ECMO who underwent
Video-assisted thoracoscopic surgery (VATS) and Bilateral Cardiac
Sympathetic Denervation (BCSD)