Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias

Area of Science:

• Cardiology
• Electrophysiology
• Cardiac Surgery

Background:

• Cardiac sympathetic denervation (CSD) is a potential therapy for refractory ventricular arrhythmias (VT) in patients with structural heart disease (SHD).
• Previous studies suggest CSD may reduce implantable cardioverter-defibrillator (ICD) shocks, but data in larger cohorts are limited.

Purpose of the Study:

• To assess the efficacy of CSD in reducing ICD shocks and mortality in patients with SHD and refractory VT.
• To identify patient and procedural characteristics associated with outcomes after CSD.

Main Methods:

• A retrospective analysis of 121 patients with SHD undergoing CSD for refractory VT or VT storm across 5 international centers.
• Kaplan-Meier analysis for freedom from ICD shock, heart transplantation, and death.
• Cox proportional hazards models to determine predictors of ICD shock recurrence and mortality.

Main Results:

• CSD significantly reduced the burden of ICD shocks from a mean of 18 to 2.0 per year (p < 0.01).
• One-year freedom from sustained VT/ICD shock was 58%, and freedom from ICD shock, transplant, or death was 50%.
• Advanced NYHA class, longer VT cycle lengths, and left-sided-only procedures were associated with adverse outcomes.

Conclusions:

• CSD is effective in decreasing sustained VT and ICD shock recurrence in patients with refractory VT.
• Advanced heart failure, VT cycle length, and unilateral CSD are independent predictors of recurrence and mortality.