STORMS-A-BREWIN: USE OF SYMPATHECTOMY IN TREATMENT OF REFRACTORY VENTRICULAR TACHYCARDIA STORM PROVOKED BY THYROID STORM IN A PATIENT WITH STRUCTURAL HEART DISEASE

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Sympathectomy has been used since the 1960s for treatment of refractory ventricular tachycardia (VT)(1). However, procedure not studied with a randomized controlled trial; clear indications and outcome data remain unclear. In this case report, we describe use sympathectomy in patient VT storm provoked by thyroid setting underlying structural heart disease. CASE PRESENTATION: The is 60-year-old male history biventricular systolic failure secondary to ischemic cardiomyopathy (ICM). addition ICM, he had which underwent two prior ablations (20 months 2 admission) as well permanent pacemaker implantation. One month presentation, was diagnosed hyperthyroidism treated methimazole. He presented our institution clinic appointment but collapsed hospital parking garage. shocked his 4 times before being brought ED where received an additional 10 shocks. staff determined storm. sedated propofol intubated airway protection admission ICU. Thyroid stimulating hormone found be undetectable at time, free T4 significantly elevated. Given presentation clinical history, standard therapies adequately suppressed propofol. On day 2, sedation discontinued, extubated without complication. Unfortunately, continued have runs on days 2-6. previous storm, elected pursue bilateral VATS (hospital 6) attempting third ablation 10). complicated RV perforation requiring pericardiocentesis. remained from 6 until discharge 12. subsequent follow up appointments. DISCUSSION: To knowledge, first reported involving Arrhythmias caused are typically atrial nature, few reports primary arrhythmias. Ventricular arrhythmias classically thought associated CONCLUSIONS: shown effective VT, more research needed area better characterize outcomes(2,3). REFERENCE #1: Estes EH Jr., Izlar HL Jr. Recurrent tachycardia. A successfully cardiac sympathectomy. Am J Med. 1961;31:493-497. #2: Vaseghi M, Gima J, Kanaan C, et al. Cardiac sympathetic denervation patients or electrical storm: intermediate long-term follow-up. Heart Rhythm. 2014;11(3):360-366. doi:10.1016/j.hrthm.2013.11.028 #3: Barwad P, Malavassi Corrales FJ, Sympathetic Denervation Refractory [published correction appears Coll Cardiol. 2017 Aug 8;70(6):811]. 2017;69(25):3070-3080. doi:10.1016/j.jacc.2017.04.035 DISCLOSURES: No relevant relationships James Collins, source=Web Response John Tepper,