Advertisement

Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with structural heart disease: A systematic review

      Background

      Cardiac sympathetic denervation (CSD) is an important adjunctive option for patients with refractory ventricular arrhythmias (VAs). Reports of efficacy of CSD in patients with structural heart disease (SHD) and refractory VA vary widely in literature.

      Objective

      The purpose of this study was to conduct a systematic review of arrhythmic outcomes and complications in patients with SHD who underwent CSD due to recurrent VAs.

      Methods

      Electronic databases (Google Scholar and PubMed) were searched to identify reports on CSD in SHD using appropriate medical subject terms. No sample size restriction was applied. All patients with known channelopathies were excluded. Baseline demographic and surgical data, arrhythmic outcomes, and procedural complications were evaluated.

      Results

      A total of 13 studies and 173 patients were included. Of the 173 patients (121 [70%] male); pooled mean age 54.6 [95% confidence interval 52.6–56.7] years), 48 (28%) had ischemic cardiomyopathy, and 141 (82%) underwent bilateral CSD. Overall freedom from events ranged from 58% to 100%. Complications were reported in 49 patients(28%). Transient hypotension (9%), pneumothorax (5%), neuropathic pain (skin sensitivity) (4%), Horner syndrome (3%), sweating pattern changes (3%), and hemothorax (2%) were the most common complications. No procedure-related deaths were reported.

      Conclusion

      CSD reduced the number of VA events in patients with SHD, and the benefit from the intervention seemed to be independent of the underlying SHD. Although overall rate of postprocedural complications was high, most of the complications were temporary. Major postprocedural complications after CSD were infrequent.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Khatib S.M.
        • Stevenson W.G.
        • Ackerman M.J.
        • et al.
        2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.
        Journal of the American College of Cardiology. 2018; 72: e91-e220
        • Poole J.E.
        • Johnson G.W.
        • Hellkamp A.S.
        • et al.
        Prognostic importance of defibrillator shocks in patients with heart failure.
        N Engl J Med. 2008; 359: 1009-1017
        • Tung R.
        • Vaseghi M.
        • Frankel D.S.
        • et al.
        Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an international VT ablation center collaborative group study.
        Heart Rhythm. 2015; 12: 1997-2007
        • Vaseghi M.
        • Barwad P.
        • Malavassi Corrales F.J.
        • et al.
        Cardiac sympathetic denervation for refractory ventricular arrhythmias.
        J Am Coll Cardiol. 2017; 69: 3070-3080
        • Wilde A.A.
        • Bhuiyan Z.A.
        • Crotti L.
        • et al.
        Left cardiac sympathetic denervation for catecholaminergic polymorphic ventricular tachycardia.
        N Engl J Med. 2008; 358: 2024-2029
        • Collura C.A.
        • Johnson J.N.
        • Moir C.
        • Ackerman M.J.
        Left cardiac sympathetic denervation for the treatment of long QT syndrome and CPVT using video-assisted thoracic surgery.
        Heart Rhythm. 2009; 6: 752-759
        • Schwartz P.J.
        • Priori S.G.
        • Cerrone M.
        • et al.
        Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome.
        Circulation. 2004; 109: 1826-1833
        • De Ferrari G.M.
        • Dusi V.
        • Spazzolini C.
        • et al.
        Clinical management of CPVT: the role of left cardiac sympathetic denervation.
        Circulation. 2015; 131: 2185-2193
        • Johnson J.N.
        • Harris K.M.
        • Moir C.
        • Lau Y.R.
        • Ackerman M.J.
        Left cardiac sympathetic denervation in a pediatric patient with hypertrophic cardiomyopathy and recurrent ventricular fibrillation.
        Heart Rhythm. 2011; 8: 1591-1594
        • Estes Jr., E.H.
        • Izlar Jr., H.L.
        Recurrent ventricular tachycardia. A case successfully treated by bilateral cardiac sympathectomy.
        Am J Med. 1961; 31: 493-497
        • Kopecky K.
        • Afzal A.
        • Felius J.
        • et al.
        Bilateral sympathectomy for treatment of ventricular tachycardia.
        Pacing Clin Electrophysiol. 2018; 41: 93-95
        • Richardson T.
        • Lugo R.
        • Saavedra P.
        • et al.
        Cardiac sympathectomy for the management of ventricular arrhythmias refractory to catheter ablation.
        Heart Rhythm. 2018; 15: 56-62
        • Amer M.
        • Burrows W.M.
        • Dickfeld T.M.
        Unilateral sympathetic ganglion denervation in the management of sustained VT.
        HeartRhythm Case Rep. 2017; 3: 467-469
        • Assis F.R.
        • Krishnan A.
        • Zhou X.
        • et al.
        Cardiac sympathectomy for refractory ventricular tachycardia in ARVC.
        Heart Rhythm. 2019; 16: 1003-1010
        • Okada D.R.
        • Assis F.R.
        • Gilotra N.A.
        • et al.
        Cardiac sympathectomy for refractory ventricular arrhythmias in cardiac sarcoidosis.
        Heart Rhythm. 2019; (pii:S1547-5271(19)30147-X)
        • Dusi V.
        • Pugliese L.
        • Castelletti S.
        • et al.
        P297 cardiac sympathetic denervation: evolving technique, expanding indications.
        Eur Heart J. 2018; 39 (P297): ehy564
        • Gutierrez O.
        • Garita E.
        • Salazar C.
        Thoracoscopic sympathectomy for incessant polymorphic ventricular tachycardia in chronic chagasic myocarditis—a case report.
        Int J Cardiol. 2007; 119: 255-257
        • Gadhinglajkar S.
        • Sreedhar R.
        • Unnikrishnan M.
        • Namboodiri N.
        Electrical storm: role of stellate ganglion blockade and anesthetic implications of left cardiac sympathetic denervation.
        Indian J Anaesth. 2013; 57: 397-400
        • Téllez L.J.
        • Garzón J.C.
        • Vinck E.E.
        • Castellanos J.D.
        Video-assisted thoracoscopic cardiac denervation of refractory ventricular arrhythmias and electrical storms: a single-center series.
        J Cardiothorac Surg. 2019; 14: 17
        • Coleman M.A.
        • Bos J.M.
        • Johnson J.N.
        • et al.
        Videoscopic left cardiac sympathetic denervation for patients with recurrent ventricular fibrillation/malignant ventricular arrhythmia syndromes besides congenital long-QT syndrome.
        Circ Arrhythm Electrophysiol. 2012; 5: 782-788
        • Vaseghi M.
        • Gima J.
        • Kanaan C.
        • et al.
        Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow-up.
        Heart Rhythm. 2014; 11: 360-366
        • Schwartz P.J.
        Cardiac sympathetic denervation to prevent life-threatening arrhythmias.
        Nat Rev Cardiol. 2014; 11: 346-353
        • Schwartz P.J.
        • Stone H.L.
        Left stellectomy in the prevention of ventricular fibrillation caused by acute myocardial ischemia in conscious dogs with anterior myocardial infarction.
        Circulation. 1980; 62: 1256-1265
        • Schwartz P.J.
        • Vanoli E.
        Cardiac arrhythmias elicited by interaction between acute myocardial ischemia and sympathetic hyperactivity: a new experimental model for the study of antiarrhythmic drugs.
        J Cardiovasc Pharmacol. 1981; 3: 1251-1259
        • Schwartz P.J.
        • Vanoli E.
        • Zaza A.
        • Zuanetti G.
        The effect of antiarrhythmic drugs on life-threatening arrhythmias induced by the interaction between acute myocardial ischemia and sympathetic hyperactivity.
        Am Heart J. 1985; 109: 937-948
        • Moss A.J.
        • McDonald J.
        Unilateral cervicothoracic sympathetic ganglionectomy for the treatment of long QT interval syndrome.
        N Engl J Med. 1971; 285: 903-904
        • Yagishita D.
        • Chui R.W.
        • Yamakawa K.
        • et al.
        Sympathetic nerve stimulation, not circulating norepinephrine, modulates T-peak to T-end interval by increasing global dispersion of repolarization.
        Circ Arrhythm Electrophysiol. 2015; 8: 174-185
        • Vaseghi M.
        • Yamakawa K.
        • Sinha A.
        • et al.
        Modulation of regional dispersion of repolarization and T-peak to T-end interval by the right and left stellate ganglia.
        Am J Physiol Heart Circ Physiol. 2013; 305: H1030
        • Schwartz P.J.
        • Motolese M.
        • Pollavini G.
        • et al.
        Prevention of sudden cardiac death after a first myocardial infarction by pharmacologic or surgical antiadrenergic interventions.
        J Cardiovasc Electrophysiol. 1992; 3: 2-16
        • Bourke T.
        • Vaseghi M.
        • Michowitz Y.
        • et al.
        Neuraxial modulation for refractory ventricular arrhythmias: value of thoracic epidural anesthesia and surgical left cardiac sympathetic denervation.
        Circulation. 2010; 121: 2255-2262
        • Ajijola O.A.
        • Lellouche N.
        • Bourke T.
        • et al.
        Bilateral cardiac sympathetic denervation for the management of electrical storm.
        J Am Coll Cardiol. 2012; 59: 91-92
        • Antiel R.M.
        • Bos J.M.
        • Joyce D.D.
        • et al.
        Quality of life after videoscopic left cardiac sympathetic denervation in patients with potentially life-threatening cardiac channelopathies/cardiomyopathies.
        Heart Rhythm. 2016; 13: 62-69
        • Waddell-Smith K.E.
        • Ertresvaag K.N.
        • Li J.
        • et al.
        Physical and psychological consequences of left cardiac sympathetic denervation in long-QT syndrome and CPVT.
        Circ Arrhythm Electrophysiol. 2015; 8: 1151-1158
        • Webster G.
        • Monge M.C.
        Left cardiac sympathetic denervation: should we sweat the side effects?.
        Circ Arrhythm Electrophysiol. 2015; 8: 1007-1009