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Outcomes following cardiac sympathetic denervation in patients with structural heart disease and refractory

Sebastian König1,2, Thomas Schröter3, Michael A Borger3

  • 1Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|July 19, 2022
PubMed

Insights

Cardiac sympathetic denervation (CSD) offers moderate efficacy for refractory ventricular arrhythmias (VAs) after ablation. While CSD-related complications were acceptable, overall risks of adverse events and death remain high.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Electrophysiology

Background:

  • Cardiac sympathetic denervation (CSD) is an emerging bailout therapy for refractory ventricular arrhythmias (VAs) in patients with structural heart disease.
  • Limited data exist on the efficacy and safety of CSD, particularly after failed catheter ablation.

Purpose of the Study:

  • To evaluate the immediate results, complications, and mid-term outcomes of CSD.
  • To assess CSD as a salvage therapy for recurrent VAs post-catheter ablation.

Main Methods:

  • Retrospective analysis of 21 adult patients undergoing CSD via video-assisted thoracoscopic surgery.
  • Follow-up included ICD interrogation, telephone interviews, and medical record review.
  • Patients had structural heart disease, refractory VAs, and often presented with electrical storm.

Main Results:

  • CSD was performed bilaterally in 90.5% of patients for monomorphic ventricular tachycardia (76.2%) or ventricular fibrillation (23.8%).
  • Procedure-related major complications occurred in 9.5%; in-hospital non-surgical adverse events were 28.6%, with two deaths.
  • Mean follow-up was 9.1 months. At 9 months, 38.5% were free from VAs and 76.9% were free from ICD shocks.

Conclusions:

  • CSD demonstrates moderate efficacy in suppressing VAs as a bailout therapy post-catheter ablation.
  • The rate of CSD-related complications was acceptable in this high-comorbidity population.
  • Despite moderate efficacy, there is a significant risk of procedure-unrelated adverse events and mortality.
Abstract

Keywords:
Cardiac sympathetic denervationCatheter ablationDrug-refractory arrhythmiaVentricular arrhythmiaVentricular tachycardia

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