Gurau Andrei, Bosmans Frank, Barth Andreas, Brock Malcolm V, Ha Jinny S
Division of Thoracic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Department of Basic and Applied Medical Sciences, University of Ghent, Ghent, Belgium.
J Clin Exp Cardiolog. 2024;15(3). Epub 2024 Mar 14.
Surgical Cardiac Sympathetic Denervation (CSD) has gained traction as a promising neuromodulatory therapy for Refractory Ventricular Tachyarrhythmias (RVT), particularly in patients with channelopathies and Ischemic (ICM) and Non-Ischemic Cardiomyopathies (NICM) who are refractory to conventional treatment. This mini review examines the pathophysiological role of the sympathetic nervous system in RVT and assesses the efficacy of Bilateral CSD (BCSD) through a literature review. Historical perspectives have traced the evolution of CSD from its initial use in intractable angina to its current application in ventricular arrhythmias. BCSD is associated with improved outcomes for refractory ventricular arrhythmias, with studies demonstrating approximately 60% reductions in implantable cardioverter defibrillator shocks and over 50% shock-and transplant-free survival at 1 year after BCSD. Notably, the 2017 AHA/ACC/HRS guidelines recommend Left CSD (LCSD) for certain etiologies of RVT, including congenital long QT syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), and VT/VF storm. Both Video-Assisted Thoracoscopic Surgery (VATS) and Robot-Assisted Thoracoscopic Surgery (RATS) BCSD are performed, with shorter operative times for RATS. Yet, most RVT CSD studies have a small sample size; therefore, complications may be underreported because the studies are underpowered. Although BCSD has superior reported outcomes with respect to left CSD, there may be confounding factors due to the selection of healthier patients for BCSD. Additional comparative effectiveness and cost-effectiveness data are needed to guide clinical practice. In conclusion, BCSD can restore the quality of life of severely impacted RVT patients; however, the benefits must be weighed against procedure-related risks, and further research should clarify the impact on long-term morbidity and mortality.
外科心脏交感神经去神经术（CSD）作为一种有前景的神经调节疗法，已在难治性室性心律失常（RVT）的治疗中获得关注，尤其是对于患有通道病、缺血性心肌病（ICM）和非缺血性心肌病（NICM）且对传统治疗无效的患者。这篇小型综述通过文献回顾，探讨了交感神经系统在RVT中的病理生理作用，并评估了双侧CSD（BCSD）的疗效。历史观点追溯了CSD从最初用于顽固性心绞痛到目前在室性心律失常中的应用演变。BCSD与难治性室性心律失常的预后改善相关，研究表明，在BCSD后1年，植入式心律转复除颤器电击次数减少约60%，无电击和移植生存率超过50%。值得注意的是，2017年美国心脏协会/美国心脏病学会/心律学会指南推荐对某些RVT病因，包括先天性长QT综合征、儿茶酚胺能多形性室性心动过速（CPVT）和室性心动过速/心室颤动风暴，采用左CSD（LCSD）。BCSD可通过电视辅助胸腔镜手术（VATS）和机器人辅助胸腔镜手术（RATS）进行，RATS的手术时间更短。然而，大多数RVT CSD研究的样本量较小；因此，由于研究效能不足，并发症可能报告不足。尽管BCSD的报告结果优于左CSD，但由于选择了更健康的患者进行BCSD，可能存在混杂因素。需要更多的比较有效性和成本效益数据来指导临床实践。总之，BCSD可以恢复严重受影响的RVT患者的生活质量；然而，必须权衡其益处与手术相关风险，进一步的研究应阐明其对长期发病率和死亡率的影响。
