Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with inherited cardiomyopathies

Cardiac sympathetic denervation (CSD) is a therapeutic option in patients with recurrent or refractory ventricular arrhythmia (VA). Successful outcomes have largely been established among patients with underlying ischemic cardiomyopathy, patients with nonischemic cardiomyopathy, and young patients diagnosed as having long-QT syndrome or catecholaminergic polymorphic ventricular tachycardia. Patients with inherited cardiomyopathies have a rare prevalence but experience VAs and sudden cardiac death.

Herein, we studied the outcomes of CSD on patients with refractory VA and an inherited cardiomyopathy.

Data from adult patients with VA referred for CSD were reviewed from 4 tertiary referral centers between 2010 and 2023. Patients with a minimum postoperative follow-up time of 12 months and an inherited cardiomyopathy were included: hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy.

23 patients with an inherited cardiomyopathy underwent bilateral CSD: 7 patients with hypertrophic cardiomyopathy, 11 patients with arrhythmogenic cardiomyopathy, and 5 patients with dilated cardiomyopathy. The median (interquartile range) follow-up time was 34.5 months (23.1-46.5). The overall success rate of CSD was 48%. When comparing pre- and post-CSD periods, implantable cardioverter-defibrillator shocks decreased by 61% (P < .01). Transplant-free survival at 4 years was 76%. Most of the expected complications resolved upon follow-up.

Bilateral CSD significantly reduced implantable cardioverter-defibrillator shocks in patients with inherited cardiomyopathies, demonstrating durable arrhythmia control and favorable long-term transplant-free survival across diverse genetic subtypes.