Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig 04289, Germany.
Leipzig Heart Institute, Leipzig, Germany.
Europace. 2022 Nov 22;24(11):1800-1808. doi: 10.1093/europace/euac078.
Cardiac sympathetic denervation (CSD) has been introduced as a bailout therapy in patients with structural heart disease and refractory ventricular arrhythmias (VAs), but available data are scarce. Purpose of this study was to estimate immediate results, complications, and mid-term outcomes of CSD following recurrent VA after catheter ablation.
Adult patients who underwent CSD in the Heart Center Leipzig from March 2017 to February 2021 were retrospectively analysed. Follow-up (FU) was executed via implantable cardioverter defibrillator (ICD) interrogation, telephone interviews, and reviewing medical records. Twenty-one patients (age 63.7 ± 14.4 years, all men, 71.4% non-ischaemic cardiomyopathy, left ventricular ejection fraction 31.6 ± 12.6%) received CSD via video-assisted thoracoscopic surgery (90.5% bilateral, 9.5% left-sided only). Indication for CSD was monomorphic ventricular tachycardia in 76.2% and ventricular fibrillation in 23.8 with 71.4% of patients presenting with electrical storm before index hospitalization. Procedure-related major complications occurred in 9.5% of patients. In-hospital adverse events not related to surgery were common (28.6%) and two patients died during the index hospital stay. During FU (mean duration 9.1 ± 6.5 months), five more patients died. Of the remaining patients, 38.5 and 76.9% were free from any VA or ICD shocks, respectively.
The CSD showed additional moderate efficacy to suppress VAs, when performed as a bailout therapy after previously unsuccessful catheter ablation. At 9 months, it was associated with freedom of ICD shocks in two-thirds of patients. In a population with many comorbidities, the rate of CSD-related complications was acceptable, although there was an overall high risk of procedure unrelated adverse events and death.
心脏去交感神经支配（CSD）已被引入结构性心脏病和难治性室性心律失常（VA）患者的抢救治疗中，但可用数据很少。本研究的目的是评估导管消融后复发性 VA 后行 CSD 的即刻结果、并发症和中期结果。
回顾性分析 2017 年 3 月至 2021 年 2 月在莱比锡心脏中心行 CSD 的成年患者。通过植入式心脏复律除颤器（ICD）询问、电话访谈和审查病历进行随访（FU）。21 例患者（年龄 63.7±14.4 岁，均为男性，71.4%为非缺血性心肌病，左室射血分数 31.6±12.6%）接受了经电视辅助胸腔镜手术（90.5%双侧，9.5%仅左侧）的 CSD。CSD 的适应证为 76.2%的单形性室性心动过速和 23.8%的室颤，71.4%的患者在指数住院前出现电风暴。9.5%的患者发生与手术相关的主要并发症。非手术相关的住院不良事件很常见（28.6%），2 例患者在指数住院期间死亡。FU 期间（平均持续时间 9.1±6.5 个月），又有 5 例患者死亡。其余患者中，38.5%和 76.9%分别无任何 VA 或 ICD 电击。
CSD 作为先前不成功的导管消融后的抢救治疗时，对抑制 VA 具有额外的中等疗效。在 9 个月时，三分之二的患者 ICD 电击无电击。在合并多种疾病的人群中，CSD 相关并发症的发生率是可以接受的，尽管与操作无关的不良事件和死亡的总体风险较高。
