Left cardiac sympathetic denervation in CPVT patients was associated with a 17% rate of cardiac events over a median 48 months, reducing ICD shocks by 67% and electrical storms by 80%.
Observational (n=162)
Yes
Does left cardiac sympathetic denervation (LCSD) reduce cardiac events in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT)?
LCSD is highly effective in reducing cardiac events in CPVT patients, suggesting that routine ICD implantation may not be necessary for compliant patients post-LCSD.
BACKGROUND: The management of catecholaminergic polymorphic ventricular tachycardia (CPVT) patients with drug refractory cardiac events (CEs) is challenging. OBJECTIVES: This study sought to assess the efficacy of left cardiac sympathetic denervation (LCSD) in 162 CPVT patients, focusing on those symptomatic without a high-risk genotype and compliant to therapy (main subanalysis, n = 118) of whom 41 had syncope on medical therapy. CEs included syncope, sudden cardiac arrest (SCA), sudden cardiac death (SCD), and appropriate implantable cardioverter-defibrillator (ICD) interventions. METHODS: A retrospective study including 162 CPVT patients (51% female, 80% probands, 79% RYR2 positive) who underwent LCSD worldwide. RESULTS: Most (n = 139; 85%) of the 162 patients experienced ≥1 CE before LCSD, 84 (52%) had CEs despite medical therapy, and 43 (27%) had previous SCA. Overall, 93% received a beta-blocker (nonselective in 85%), 53% both a beta-blocker and a class I antiarrhythmic drug, and 55% (89) had an ICD before LCSD. During a median of 48 months (Q1-Q3: 12-111 months) after LCSD, 28 of 162 patients (17%) had ≥1 CE, including 10 of 28 (36%) during noncompliance. Of the 118 patients (main subanalysis), 13% suffered CEs after LCSD, including 3 SCAs and 1 SCD despite an ICD (3%). Of the 41 with syncope on medical therapy, 6 (15%) experienced CEs after LCSD, including the SCD despite an ICD (3%). LCSD improved quality of life by reducing ICD shocks by 67% and electrical storms by 80%. CONCLUSIONS: Our data suggest that probably <5% of symptomatic CPVT patients compliant to medical therapy require an ICD after LCSD. ICDs do not reliably prevent SCD.
Bos et al. (Fri,) conducted a observational in Catecholaminergic polymorphic ventricular tachycardia (CPVT) (n=162). Left cardiac sympathetic denervation (LCSD) was evaluated on Cardiac events (CEs) including syncope, sudden cardiac arrest (SCA), sudden cardiac death (SCD), and appropriate implantable cardioverter-defibrillator (ICD) interventions. Left cardiac sympathetic denervation in CPVT patients was associated with a 17% rate of cardiac events over a median 48 months, reducing ICD shocks by 67% and electrical storms by 80%.