OBJECTIVE: Although cardiac sympathetic denervation (CSD) effectively manages refractory ventricular tachyarrhythmias (RVTs) in long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia, the link between dysautonomia and RVT from broader etiologies is understudied. We hypothesized that dysautonomia is linked to RVT regardless of etiology in patients requiring CSD. We aimed to determine whether these patients have a high burden of dysautonomia symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31). METHODS: COMPASS-31 surveys were administered to 37 patients with RVT who underwent CSD and 37 matched healthy controls. COMPASS-31 scores were compared using Mann-Whitney RESULTS: Common operative indications were idiopathic ventricular arrhythmias (49%) and arrhythmogenic right ventricular cardiomyopathy (30%). Patients with RVT had significantly greater COMPASS-31 scores (median 25.3) compared with control patients (median 8.6, CONCLUSIONS: Dysautonomia symptoms are significantly associated with RVT requiring CSD, regardless of underlying etiology. This association, in the context of CSD efficacy in RVT across structural and nonstructural etiologies, highlights autonomic dysfunction as a common pathophysiologic link warranting further investigation.