Left Cardiac Sympathetic Denervation for Long QT Syndrome: 50 Years' Experience Provides Guidance for Management
Veronica Dusi1, Luigi Pugliese2, Gaetano M De Ferrari3
1Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy; Division of Cardiology, Cardiovascular and Thoracic Department, Azienda Ospedaliera Universitaria "Città della Salute e della Scienza di Torino", Turin, Italy.
JACC. Clinical Electrophysiology
|March 25, 2022
Summary
Left cardiac sympathetic denervation (LCSD) effectively treats long QT syndrome (LQTS), significantly reducing cardiac events. Patient outcomes depend on individual risk and QTc interval shortening post-procedure.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Long QT syndrome (LQTS) is a serious arrhythmia condition.
- Left cardiac sympathetic denervation (LCSD) is underutilized due to clinical uncertainty compared to implantable cardioverter-defibrillators (ICDs).
- This study evaluates long-term outcomes of LCSD in LQTS patients.
Purpose of the Study:
- To report a single-center experience with LCSD for LQTS.
- To provide evidence for LCSD's long-term efficacy.
- To guide clinical decision-making for LQTS management.
Main Methods:
- Retrospective analysis of 125 LQTS patients undergoing LCSD.
- Patients categorized into four risk groups: very high risk, aborted cardiac arrest (ACA), syncope/ICD shocks, and primary prevention.
- Long-term follow-up (12.9 ± 10.3 years) assessing cardiac event rates and QTc intervals.
Main Results:
- LCSD significantly reduced the mean yearly cardiac event rate by 86% (P < 0.0001).
- Asymptomatic rates post-LCSD varied by risk group (17% to 97%).
- A post-LCSD QTc < 500 ms predicted excellent outcomes; QTc shortening averaged 60 ms for those with QTc ≥ 500 ms.
Conclusions:
- Definitive evidence supports the long-term efficacy of LCSD in LQTS.
- Antiarrhythmic protection is influenced by patient risk and QTc shortening.
- Outcomes analysis aids in tailoring management strategies for individual LQTS patients.
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