Cardiac sympathetic denervation for different cardiovascular indications - the experience of two referral centers

Abstract Cardiac sympathetic denervation (CSD) reduces risk of ventricular tachyarrhythmias (VTA in long-QT syndrome, catecholaminergic polymorphic ventricular tachycardia and cardiomyopathies. CSD has also a theoretical potential to be alleviate symptoms in other disorders dependent on adrenergic input. The aim of this study was to assess efficacy and safety of bilateral CSD (BCSD) procedure performed for wide range of cardiovascular disorders. Apart form efficacy of CSD also physical and psychological consequences and patient satisfaction were studied. Methods and results Between 2018 - 2024 51 patients were qualified for BCSD in 2 centers in Poland. The median age of patients was 46,8 (range 17-78) years, 26 were males, 22 had prior ICD implants. In 4 cardioneuroablation was also performed. In 49 patients video- and in 2 robot-assisted BCSD ob T1-T4(5) chain was performed for recurrent VTA or electric storm in 41, coronary spam (5), Takotsubo cardiomyopathy (1), inappropriate sinus tachycardia (1) and Raynaud syndrome (9) . Several patients had multiple indications. In two patients with DCM VTA recurred within a week after CSD and also thereafter. There were 5 deaths on follow-up in the course of underlying disease, none was linked directly to BCSD. One death occurred in a patient in whom CSD was a last resort for refractory VT storm. Persistent neuropathic pain was the main adverse effect reported by patients. In the group of patients in whom both CSD and CNA wee performed no serious AE were observed. Conclusions BiCSD is an effective when performed for various cardiovascular indications such as recurrent ventricular tachyarrytmias, coronary spasm and Raynaud syndrome. BCSD is also well tolerated by majority of patients. The failure of antiarrhythmic effect shortly after the procedure in 2 patients with dilated cardiomyopathy and low EF needs to be elucidated in further studies.