Key result
Cardiac sympathetic denervation demonstrated a protective effect against ventricular arrhythmias in both primary and secondary prevention strategies across all included observational studies.
Why the study?
Indications for cardiac sympathectomy have expanded, but large randomised controlled trials are non-existent, leaving its overall utility across all ventricular arrhythmias unclear.
Does surgical cardiac sympathetic denervation prevent ventricular arrhythmias in patients with refractory disease or medication intolerance?
Systematic Review
Does surgical cardiac sympathetic denervation prevent ventricular arrhythmias in patients with refractory disease or medication intolerance?
Cardiac sympathetic denervation provides a protective effect against ventricular arrhythmias in patients with refractory disease or medication intolerance.
Answers are grounded in this paper and cite their sources.
May support earlier sympathectomy for refractory ventricular arrhythmias; extends indications but leaves open confirmation by large RCTs.
Background: The antiadrenergic and antifibrillatory effects of cardiac sympathectomy in pathological states such as long QT syndrome are well established. The indications for the procedure have expanded since the videoassisted thoracoscopic approach was first used. However, the procedure is currently largely used in cases where medication has failed to prevent recurrence of symptomatic ventricular arrhythmia, or in cases of medication intolerance, and large randomised controlled trials are thus non-existent in the literature. The aim of this study was to perform a systematic review of the available literature to examine the utility of cardiac denervation in the management of all ventricular arrhythmias. Methods: A total of 17 studies published between 2009 and 2019 were evaluated for bias using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool. In addition the Harbour and Miller Grading System (2001) was used to assess the significance of the evidence in this review. Results: All studies demonstrated a protective effect of sympathectomy against ventricular arrhythmias in both primary and secondary prevention strategies. The following risk of bias was observed: low in 5 studies, moderate in 8 studies, and serious risk in 4 studies. The highest level of evidence observed was 2++ in 3 studies. Conclusion: Cardiac sympathetic denervation provides benefit for patients with ventricular arrhythmias, in cases of refractory disease or in patients who require a primary prevention strategy where first-line therapies are not tolerated.
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Casey et al. (2022) conducted a systematic review in Ventricular arrhythmias. Surgical cardiac sympathetic denervation vs. Pre-operative baseline or standard of care was evaluated on Reduction in cardiac deaths and cardiac events (breakthrough cardiac events or ICD discharges). Cardiac sympathetic denervation demonstrated a protective effect against ventricular arrhythmias in both primary and secondary prevention strategies across all included observational studies.
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