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Trigger Type and Breakthrough Cardiac Events in Inherited Arrhythmia Syndromes After Left Cardiac Sympathetic

Vanessa Karlinski Vizentin1, Iuri Ferreira Felix2, Sahej Bains3

  • 1Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: https://twitter.com/VizentinVanessa.

JACC. Clinical Electrophysiology
|April 24, 2026
PubMed
Abstract

Insights

Left cardiac sympathetic denervation (LCSD) is more effective for patients with genetic heart conditions whose symptoms are triggered by adrenergic factors. Patients with non-adrenergic triggers experienced more breakthrough cardiac events after LCSD.

Area of Science:

  • Cardiology
  • Genetics
  • Electrophysiology

Background:

  • Left cardiac sympathetic denervation (LCSD) is a proven therapy for genetic heart diseases like long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT).
  • The study investigates if LCSD's effectiveness varies based on whether symptoms are triggered by adrenergic (AD) or non-adrenergic (non-AD) factors before the procedure.

Purpose of the Study:

  • To determine the association between AD and non-AD triggered events and the risk of breakthrough cardiac events (BCEs) following LCSD.
  • To evaluate the impact of pre-LCSD symptom triggers on therapeutic outcomes in patients with LQTS and CPVT.

Main Methods:

  • Retrospective review of patients with LQTS or CPVT who underwent LCSD since 2005.
  • Abstraction of electronic medical records to identify cardiac event (CE) trigger types (AD vs. non-AD) before and after LCSD.
  • Definition of CEs and BCEs included syncope, seizures, appropriate defibrillator therapies, and sudden cardiac arrest/death.

Main Results:

  • Among 154 patients (LQTS: 105, CPVT: 49), 32% experienced BCEs post-LCSD.
  • Patients with non-AD triggered CEs had significantly higher BCE rates (54%) compared to those with AD-triggered CEs (19%; P < 0.0001).
  • LQT1 patients with AD triggers showed the fewest BCEs (OR: 0.24, P < 0.0001); no BCEs occurred in LQT2, LQT3, or LQT Minor patients with AD triggers.

Conclusions:

  • Pre-LCSD symptom triggers are a significant determinant of LCSD's therapeutic efficacy.
  • Patients with AD-triggered symptoms experience a greater reduction in disease-mediated BCEs, irrespective of their specific genotype.
  • LCSD offers substantial benefit, particularly for patients with AD-triggered genetic arrhythmias.
Keywords:
adrenergiccatecholaminergic polymorphic ventricular tachycardialeft cardiac sympathetic denervationlong QT syndrome

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