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)