Left cardiac sympathetic denervation significantly reduces the incidence of life-threatening cardiac events and ICD shocks in high-risk patients with Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia.
Does left cardiac sympathetic denervation reduce life-threatening arrhythmias in patients with channelopathies?
Left cardiac sympathetic denervation provides a strong anti-fibrillatory effect through multiple mechanisms, offering a highly effective treatment for patients with channelopathies who are refractory or intolerant to beta-blockers.
Left cardiac sympathetic denervation (LCSD) is a surgical antiadrenergic intervention with a strong antiarrhythmic effect, supported by preclinical as well as clinical data. The mechanism of action of LCSD in structurally normal hearts with increased arrhythmic susceptibility (such as those of patients with channelopathies) is not limited to the antagonism of acute catecholamines release in the heart. LCSD also conveys a strong anti-fibrillatory action that was first demonstrated over 40 years ago and provides the rationale for its use in almost any cardiac condition at increased risk of ventricular fibrillation. The molecular mechanisms involved in the final antiarrhythmic effect of LCSD turned out to be much broader than anticipated. Beside the vagotonic effect at different levels of the neuraxis, other new mechanisms have been recently proposed, such as the antagonism of neuronal remodeling, the antagonism of neuropeptide Y effects, and the correction of neuronal nitric oxide synthase (nNOS) imbalance. The beneficial effects of LCSD have never been associated with a detectable deterioration of cardiac performance. Finally, patients express a high degree of satisfaction with the procedure. In this review, we focus on the rationale, results and our personal approach to LCSD in patients with channelopathies such as long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.
Dusi et al. (Tue,) conducted a review in Channelopathies (Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia). Left cardiac sympathetic denervation (LCSD) was evaluated. Left cardiac sympathetic denervation significantly reduces the incidence of life-threatening cardiac events and ICD shocks in high-risk patients with Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia.
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