Long‐term clinical outcomes of cardiac sympathetic denervation in patients with refractory ventricular arrhythmias

Abstract

Background Cardiac sympathetic denervation (CSD) is a useful therapeutic option in patients with structural heart disease (SHD) and ventricular tachycardia (VT) who are otherwise refractory to standard antiarrhythmic drug (AAD) therapy or catheter ablation (CA). In this study, we sought to retrospectively analyze the long‐term outcomes of CSD in patients with refractory VT and/or VT storm with a majority of the patients being taken up for CSD ahead of CA. Methods We included consecutive patients with SHD who underwent CBD from 2010 to 2019 owing to refractory VT. A complete response to CSD was defined as a greater than 75% reduction in the frequency of ICD shocks for VT. Results A total of 65 patients (50 male, 15 female) were included. The underlying VT substrate was ischemic heart disease (IHD) in 30 (46.2%) patients while the remaining 35 (53.8%) patients had other nonischemic causes. The mean duration of follow‐up was 27 ± 24 months. A complete response to CSD was achieved in 47 (72.3%) patients. There was a significant decline in the number of implantable cardioverter‐defibrillator (ICD) or external defibrillator shocks post‐CSD (24 ± 37 vs. 2 ± 4, p < .01). Freedom from a combined endpoint of ICD shock or death at 2 years was 51.5%. An advanced New York Heart Association class (III and IV) was the only parameter found to be associated with this combined endpoint. Conclusion The current retrospective analysis re‐emphasizes the role of surgical CSD and explores its role ahead of CA in the treatment of patients with refractory VT or VT storm.

Bilateral cardiac sympathetic denervation on an ECMO patient for refractory ventricular arrhythmia: A case report

“…Symptoms of arrhythmias and ICD shocks were controlled for up to 20 years postoperatively in some patients. Long‐term clinical studies have shown significant declines in ICD shocks for VT up to 2 years post‐CSD 9 . Postoperatively, our patient did not experience any VT and had improved cardiac function.…”

Sex differences on outcomes of catheter ablation of ventricular tachycardia in patients with structural heart disease: A real-world systematic review and meta-analysis

“…screened the abstracts and titles of the studies and subsequently reviewed the full-text articles for inclusion on the Covidence. 14 No language restriction was limited. A manual search for conceivably relevant studies using references of the included articles was also performed.…”

Bilateral thoracoscopic cardiac sympathetic denervation in patients with refractory ventricular tachyarrhythmias non‑responsive to other treatment

“…The latest retrospective single institutional studies indicate that if other treatment modalities such as pharmacological medication, ICD and catheter ablation fail to achieve optimal results, bilateral thoracoscopic cardiac denervation is a safe and feasible method with promising results. Most studies show an effectiveness of 70 -80 % in the fi rst month through one-year follow-up period after the procedure (18,19).…”