Left cardiac sympathetic denervation reduced the mean yearly number of cardiac events per patient by 91% (P<0.001) compared to pre-procedure rates in high-risk long-QT syndrome patients.
Observational (n=147)
Does left cardiac sympathetic denervation reduce the incidence of cardiac events in high-risk patients with long-QT syndrome?
Left cardiac sympathetic denervation significantly reduces the incidence of cardiac events and ICD shocks in high-risk LQTS patients, though it does not completely eliminate the risk of sudden cardiac death.
Effect estimate: 91% reduction
p-value: p=<0.001
BACKGROUND: The management of long-QT syndrome (LQTS) patients who continue to have cardiac events (CEs) despite beta-blockers is complex. We assessed the long-term efficacy of left cardiac sympathetic denervation (LCSD) in a group of high-risk patients. METHODS AND RESULTS: We identified 147 LQTS patients who underwent LCSD. Their QT interval was very prolonged (QTc, 543+/-65 ms); 99% were symptomatic; 48% had a cardiac arrest; and 75% of those treated with beta-blockers remained symptomatic. The average follow-up periods between first CE and LCSD and post-LCSD were 4.6 and 7.8 years, respectively. After LCSD, 46% remained asymptomatic. Syncope occurred in 31%, aborted cardiac arrest in 16%, and sudden death in 7%. The mean yearly number of CEs per patient dropped by 91% (P5 CEs declined from 55% to 8% (P<0.001). In 5 patients with preoperative implantable defibrillator and multiple discharges, the post-LCSD count of shocks decreased by 95% (P=0.02) from a median number of 25 to 0 per patient. Among 51 genotyped patients, LCSD appeared more effective in LQT1 and LQT3 patients. CONCLUSIONS: LCSD is associated with a significant reduction in the incidence of aborted cardiac arrest and syncope in high-risk LQTS patients when compared with pre-LCSD events. However, LCSD is not entirely effective in preventing cardiac events including sudden cardiac death during long-term follow-up. LCSD should be considered in patients with recurrent syncope despite beta-blockade and in patients who experience arrhythmia storms with an implanted defibrillator.
Schwartz et al. (2004) conducted an observational in Long-QT syndrome (n=147). Left cardiac sympathetic denervation (LCSD) vs. Pre-LCSD events (within-patient comparison) was evaluated on Mean yearly number of cardiac events per patient (91% reduction, p=<0.001). Left cardiac sympathetic denervation reduced the mean yearly number of cardiac events per patient by 91% (P<0.001) compared to pre-procedure rates in high-risk long-QT syndrome patients.