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Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with structural heart disease: A

Rushil Shah1, Fabrizio Assis1, Navya Alugubelli2

  • 1Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Heart Rhythm
|June 29, 2019
PubMed

Insights

Cardiac sympathetic denervation (CSD) effectively reduces ventricular arrhythmias (VAs) in patients with structural heart disease (SHD). While complications occur, most are temporary, with major issues being infrequent, making CSD a viable adjunctive therapy.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Cardiac sympathetic denervation (CSD) is a key treatment for refractory ventricular arrhythmias (VAs).
  • Efficacy of CSD in structural heart disease (SHD) patients with VAs is inconsistently reported.
  • This study addresses the variability in CSD outcomes for SHD patients.

Purpose of the Study:

  • To systematically review arrhythmic outcomes after CSD in SHD patients.
  • To evaluate procedural complications associated with CSD in this population.
  • To clarify the role of CSD in managing refractory VAs in SHD.

Main Methods:

  • Systematic review of studies on CSD in SHD patients.
  • Searched PubMed and Google Scholar for relevant literature.
  • Excluded patients with known channelopathies; analyzed demographic, surgical, and outcome data.

Main Results:

  • Included 13 studies with 173 SHD patients (mean age 54.6 years; 70% male).
  • Overall freedom from VAs ranged from 58% to 100%.
  • Complications occurred in 28% of patients, with transient hypotension and pneumothorax being most common; no procedure-related deaths.

Conclusions:

  • CSD effectively reduces VA events in SHD patients, independent of the specific heart condition.
  • The overall complication rate is notable, but most are temporary and minor.
  • CSD is a safe and effective adjunctive therapy for refractory VAs in SHD patients.
Abstract

Keywords:
Cardiac sympathetic denervationIschemic cardiomyopathyNonischemic cardiomyopathyRefractory ventricular arrhythmiasStructural heart disease

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