Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome

Area of Science:

• Cardiology
• Genetics
• Clinical Medicine

Background:

• Long-QT syndrome (LQTS) management is challenging for patients with persistent cardiac events despite beta-blocker therapy.
• High-risk LQTS patients often remain symptomatic, necessitating alternative treatment strategies.

Purpose of the Study:

• To evaluate the long-term efficacy of left cardiac sympathetic denervation (LCSD) in high-risk LQTS patients.
• To assess the reduction in cardiac events and symptoms post-LCSD.

Main Methods:

• Retrospective analysis of 147 LQTS patients undergoing LCSD.
• Comparison of cardiac event rates before and after LCSD, with an average follow-up of 7.8 years post-procedure.
• Analysis of specific LQTS genotypes (LQT1, LQT3) and their response to LCSD.

Main Results:

• LCSD reduced the yearly number of cardiac events by 91% (P<0.001).
• 46% of patients remained asymptomatic post-LCSD; syncope and aborted cardiac arrest rates decreased significantly.
• LCSD showed greater efficacy in LQT1 and LQT3 genotypes; a post-LCSD QTc <500 ms predicted a very low risk of events.

Conclusions:

• LCSD significantly reduces syncope and aborted cardiac arrest in high-risk LQTS patients.
• LCSD is not fully effective in preventing all cardiac events, including sudden cardiac death, long-term.
• LCSD is a viable option for LQTS patients with recurrent syncope or arrhythmia storms despite beta-blockade.