TY - JOUR
T1 - Cardiac sympathetic denervation for refractory ventricular arrhythmias in patients with structural heart disease
T2 - A systematic review
AU - Shah, Rushil
AU - Assis, Fabrizio
AU - Alugubelli, Navya
AU - Okada, David R.
AU - Cardoso, Rhanderson
AU - Shivkumar, Kalyanam
AU - Tandri, Harikrishna
N1 - Funding Information:
Dr Tandri receives research funding from Abbott. Dr Shivkumar was supported by National Institutes of Health Grants HL084261 and OT2OD023848. The University of California, Los Angeles, has patents developed by Dr Shivkumar relating to cardiac neural diagnostics and therapeutics. Kalyanam Shivkumar, MD, PhD, FHRS, is a cofounder of NeuCures, Inc. All other authors have reported that they have no conflicts relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019 Heart Rhythm Society
PY - 2019/10
Y1 - 2019/10
N2 - 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.
AB - 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.
KW - Cardiac sympathetic denervation
KW - Ischemic cardiomyopathy
KW - Nonischemic cardiomyopathy
KW - Refractory ventricular arrhythmias
KW - Structural heart disease
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U2 - 10.1016/j.hrthm.2019.06.018
DO - 10.1016/j.hrthm.2019.06.018
M3 - Article
C2 - 31252084
AN - SCOPUS:85072251328
SN - 1547-5271
VL - 16
SP - 1499
EP - 1505
JO - Heart Rhythm
JF - Heart Rhythm
IS - 10
ER -