Clinical outcomes of Left Cardiac Sympathetic Denervation for the treatment of pediatric inherited arrhythmias

Background – left cardiac sympathetic denervation (LCSD) is a useful adjunct treatment for inherited arrhythmias. Data regarding outcomes in younger and smaller pediatric patients remain limited. Objective We sought to describe the outcomes of LCSD in pediatric patients treated at our center. Methods – we reviewed charts of patients who underwent LCSD between 2001-2025. Patients were grouped by genetic diagnosis: catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and complex LQTS (compound heterozygotes and high-risk LQTS). Results – nineteen pediatric patients (52% male) were included: 5 with CPVT, 6 with LQTS, and 8 with complex LQTS. Five patients were younger than 1-month and weighed less than 4kg. Nearly half the cases (47%) were outpatients. Complex LQTS patients were significantly younger (p=0.02) and showed significant QTc shortening (584ms [537-637] to 524ms [500-554], p=0.016). Eleven patients (58%) underwent concurrent implantation of a pacemaker or implantable cardiac defibrillator and the remainder an implantable loop recorder. Nine of the procedures used a thoracoscopic approach. Patients were observed postoperatively for a median of 3 days (range 1-15) which was associated with age (p<0.001), weight (p=0.004) and whether they were outpatients (p=0.003). Nearly half the patients (9, 47%) and 78% (7 patients) of outpatients were admitted directly to the ward. Complications included Horner's syndrome (4, 21%) and neuropathic pain (3, 16%). In a median follow-up time of 3.4 years three patients died and two survived an aborted sudden death. Conclusion LCSD can be performed safely with good peri-operative outcomes, even in very small, young and sick infants.