ABSTRACT
Background
Long QT syndrome (LQTS) is a potentially lethal, yet treatable genetic heart disease
for which left cardiac sympathetic denervation (LCSD) is a class I recommendation.
Recent reports have suggested bilateral CSD (BiCSD) as the initial surgical denervation
therapy in LQTS.
Objective
To determine the frequency and settings in which BiCSD was used in a tertiary referral
center with expertise in LCSD.
Methods
We performed retrospective review of 234 LCSD patients/1,638 (14%) LQTS patients who
underwent sympathetic denervation at our institution to identify the subset with BiCSD.
Cardiac events (CEs) before LCSD, after LCSD, and after completion of BiCSD were recorded
and defined as being an appropriate ICD shock, arrhythmic syncope or sudden cardiac
arrest.
Results
Only 11 patients (4.7%, 6[55%] females) had BiCSD at our institution. Patients who
received BiCSD trended towards being younger at diagnosis (6±15 vs. 14±13 years, p=0.06)
and being more likely to be symptomatic (73% vs. 53%, p=0.07) than the larger LCSD-only
cohort. Continued CEs post-LCSD (3.8 CEs per patient on average) was the predominant
determinant to return for BiCSD. Over 60 combined years of follow-up, 4 patients have
not had a post-BiCSD CE, while the other 7 patients average 3.6 non-lethal CEs.
Conclusions
Less than 5% of all patients receiving denervation therapy underwent BiCSD. When BiCSD
was chosen, it was almost always done in a staged sequential manner starting with
LCSD first and when driven by the arrhythmogenicity of the LQTS substrate, despite
otherwise optimized guideline-directed therapies.
Abbreviations:
BiCSD (Bilateral cardiac sympathetic denervation), CE (Cardiac event), LCSD (Left cardiac sympathetic denervation), LQTS (Long QT syndrome), RCSD (Right cardiac sympathetic denervation), SCA (Sudden cardiac arrest), SCD (Sudden cardiac death)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 11,
2023
Received in revised form:
February 21,
2023
Received:
October 19,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This work was supported by the Mayo Clinic Windland Smith Rice Comprehensive Sudden Cardiac Death Program (MJA) and Mayo Clinic Center for Clinical and Translational Science through grant number UL1TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH).
Disclosures: MJA is a consultant for Abbott, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Invitae, Medtronic, Thryv Therapeutics, and UpToDate. MJA and Mayo Clinic have an equity/intellectual property/royalty relationship with AliveCor, Anumana, ARMGO Pharma, and Pfizer. The remaining authors have nothing to disclose.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
