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Outcomes of Bilateral Cardiac Sympathetic Denervation for Refractory VT
Quick Takes
- In a study of 20 patients with VT refractory to antiarrhythmic drugs and ablation, who were followed for 1,300 ± 321 days, 11 (55%) patients remained VT free after bilateral sympathectomy.
- Freedom from sustained VT or ICD shock was 60% and 55% at 1 and 4 years, respectively.
Study Questions:
What are the long-term arrhythmic outcomes of bilateral cardiac sympathetic denervation (BCSD)?
Methods:
The authors analyzed clinical data of consecutive patients who underwent BCSD at a single center because of refractory ventricular tachycardia (VT) and had ≥18 months of follow-up.
Results:
A total of 20 patients (mean age 42 years; 55% male) were analyzed. Nineteen patients had structural heart disease (mean left ventricular ejection fraction, 0.46). Class I or class III drugs failed for all patients; mean number of VT ablation procedures was 2.5. Over a mean follow-up of 1,300 ± 321 days, 11 (55%) patients remained VT free after sympathectomy. Freedom from sustained VT or implantable cardioverter-defibrillator (ICD) shock was 60% (95% confidence interval, 0.35-0.77) and 55% (95% confidence interval, 0.31-0.73) after BCSD at 1 and 4 years, respectively. Early VT recurrence was not associated with worse late arrhythmia-free survival rates.
Conclusions:
BCSD was associated with longstanding antiarrhythmic effects. The occurrence of an early post-VT ablation procedure was not associated with greater chance of recurrence.
Perspective:
Left-sided cardiac sympathectomy was initially shown to be effective in long QT syndrome and catecholaminergic polymorphic VT, and its use has been extended to a bilateral procedure in refractory cases and eventually to other conditions. BCSD has been shown to be associated with reduced burden of ventricular arrhythmia in many single-center studies, and at least one multicenter report. The current study extends our knowledge showing that the antiarrhythmic benefits of this procedure appear to continue in medium- to long-term follow-up. Patients in this series were young and suffered from nonischemic cardiomyopathies and Brugada syndrome. BCSD was associated with a 55% VT-free survival at 4 years. Impressively, 60% of patients in the study were off antiarrhythmic agents, other than beta-blockers, at the conclusion of follow-up. Prospective randomized studies are very much needed to define the role of this procedure in the armamentarium of the electrophysiologist.
Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, Acute Heart Failure
Keywords: Anti-Arrhythmia Agents, Arrhythmias, Cardiac, Brugada Syndrome, Cardiac Catheterization, Cardiomyopathies, Defibrillators, Implantable, Denervation, Heart Failure, Long QT Syndrome, Pharmaceutical Preparations, Shock, Stroke Volume, Sympathectomy, Tachycardia, Ventricular, Ventricular Function, Left
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