Videoscopic Left Cardiac Sympathetic Denervation for Patients With Recurrent Ventricular Fibrillation/Malignant Ventricular Arrhythmia Syndromes Besides Congenital Long-QT Syndrome

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 5; no. 4; pp. 782 - 788
• Main Authors: Coleman, Mira A, Bos, J Martijn, Johnson, Jonathan N, Owen, Heidi J, Deschamps, Claude, Moir, Christopher, Ackerman, Michael J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.08.2012; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Arrhythmogenic Right Ventricular Dysplasia - physiopathology; Arrhythmogenic Right Ventricular Dysplasia - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Child; Child, Preschool; Disease-Free Survival; Endoscopy - adverse effects; Female; Heart; Heart - innervation; Humans; Infant; Isolated Noncompaction of the Ventricular Myocardium - physiopathology; Isolated Noncompaction of the Ventricular Myocardium - surgery; Jervell-Lange Nielsen Syndrome - physiopathology; Jervell-Lange Nielsen Syndrome - surgery; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Minnesota; Recurrence; Retrospective Studies; Sympathectomy - adverse effects; Sympathectomy - methods; Sympathetic Nervous System - physiopathology; Tachycardia, Ventricular - diagnosis; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Time Factors; Treatment Outcome; Ventricular Fibrillation - diagnosis; Ventricular Fibrillation - physiopathology; Ventricular Fibrillation - surgery; Video-Assisted Surgery - adverse effects; Young Adult; Minnesota; Heart; sudden cardiac arrest; Cardiocirculatory arrest; Relapse; Left; Congenital; Arrhythmia; Prolonged QT interval; Cardiovascular disease; Ventricular tachycardia; Sudden; Recurrent; Conduction disorder; Excitability disorder; Ventricular fibrillation; catecholaminergic polymorphic ventricular tachycardia; Heart block; Heart disease; left cardiac sympathetic denervation; Denervation; Malignant syndrome
• ISSN: 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.112.971754

BACKGROUND—Treatment options for patients with recurrent ventricular arrhythmias refractory to pharmacotherapy and ablation are minimal. Although left cardiac sympathetic denervation (LCSD) is well established in long-QT syndrome, its role in non–long-QT syndrome arrhythmogenic channelopathies and cardiomyopathies is less clear. Here, we report our single-center experience in performing LCSD in this setting. METHODS AND RESULTS—In this institutional review board–approved study, we retrospectively reviewed the electronic medical records of all patients (N=91) who had videoscopic LCSD at our institution from 2005 to 2011. Data were analyzed for the subset (n=27) who were denervated for an underlying diagnosis other than autosomal dominant or sporadic long-QT syndrome. The spectrum of arrhythmogenic disease included catecholaminergic polymorphic ventricular tachycardia (n=13), Jervell and Lange-Nielsen syndrome (n=5), idiopathic ventricular fibrillation (n=4), left ventricular noncompaction (n=2), hypertrophic cardiomyopathy (n=1), ischemic cardiomyopathy (n=1), and arrhythmogenic right ventricular cardiomyopathy (n=1). Five patients had LCSD because of high-risk assessment and β-blocker intolerance, none of whom had a sentinel breakthrough cardiac event at early follow-up. Among the remaining 22 previously symptomatic patients who had LCSD as secondary prevention, all had an attenuation in cardiac events, with 18 having no breakthrough cardiac events so far and 4 having experienced ≥1 post-LCSD breakthrough cardiac event. CONCLUSIONS—LCSD may represent a substrate-independent antifibrillatory treatment option for patients with life-threatening ventricular arrhythmia syndromes other than long-QT syndrome. The early follow-up seems promising, with a marked reduction in the frequency of cardiac events postdenervation.