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Left cardiac sympathetic denervation for the prevention of life-threatening arrhythmias: The surgical supraclavicular approach to cervicothoracic sympathectomy

  • Attilio Odero
    Affiliations
    Division of Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

    Department of Lung, Blood and Heart, University of Pavia, Pavia, Italy
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  • Antonio Bozzani
    Affiliations
    Division of Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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  • Gaetano M. De Ferrari
    Affiliations
    Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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  • Peter J. Schwartz
    Correspondence
    Address reprint requests and correspondence: Dr. Peter J. Schwartz, Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, V.le Golgi, 19, 27100 Pavia, Italy
    Affiliations
    Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy

    Department of Lung, Blood and Heart, University of Pavia, Pavia, Italy

    Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy

    Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research, Department of Medicine, University of Cape Town, South Africa

    Chair of Sudden Death, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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      The progressive understanding of the diseases associated with significant risk for sudden cardiac death has fostered the development of early diagnosis and risk stratification. Thus, instead of starting from either a sudden death victim or a survivor of a cardiac arrest, it has become relatively common for cardiologists to identify individuals at high risk for sudden death, often after an arrhythmic nonlethal cardiac event such as syncope. Besides ischemic heart disease, it has also been recognized that children and young adults can be affected by arrhythmogenic disorders of genetic origin with a high propensity for lethal arrhythmias. Although β-blockers represent often the first treatment of choice, they are not always sufficiently effective, and additional protection is required. This has led to the widespread use of the implantable cardioverter-defibrillator a (ICD), a very effective device that is, however, burdened by a significant number of adverse side effects, especially common in the young. Hence, the necessity of considering—for those patients who may not have an absolute indication for an ICD and for whom the benefit-to-risk ratio is less than ideal—alternate strategies, especially if they do not represent an obstacle for subsequent ICD implant.

      Keywords

      Abbreviations:

      CPVT (catecholaminergic polymorphic ventricular tachycardia), ICD (implantable cardioverter-defibrillator), LCSD (left cardiac sympathetic denervation), LQTS (long QT syndrome)
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