Videoscopic left cardiac sympathetic denervation for patients with recurrent ventricular fibrillation/malignant ventricular arrhythmia syndromes besides congenital long-QT syndrome.

Abstract

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.

• Authors: Mira A Coleman, J Martijn Bos, Jonathan N Johnson, Heidi J Owen, Claude Deschamps, Christopher Moir, Michael J Ackerman
• Journal: Circulation. Arrhythmia and electrophysiology (Circ Arrhythm Electrophysiol) Vol. 5 Issue 4 Pg. 782-8 (Aug 01 2012) ISSN: 1941-3084 [Electronic] United States
• PMID: 22787014 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Topics

• Adolescent
• Adult
• Arrhythmogenic Right Ventricular Dysplasia (physiopathology, surgery)
• Child
• Child, Preschool
• Disease-Free Survival
• Endoscopy (adverse effects)
• Female
• Heart (innervation)
• Humans
• Infant
• Isolated Noncompaction of the Ventricular Myocardium (physiopathology, surgery)
• Jervell-Lange Nielsen Syndrome (physiopathology, surgery)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Minnesota
• Recurrence
• Retrospective Studies
• Sympathectomy (adverse effects, methods)
• Sympathetic Nervous System (physiopathology)
• Tachycardia, Ventricular (diagnosis, physiopathology, surgery)
• Time Factors
• Treatment Outcome
• Ventricular Fibrillation (diagnosis, physiopathology, surgery)
• Video-Assisted Surgery (adverse effects)
• Young Adult