C3 OUTCOME OF CARDIAC SYMPATHETIC DENERVATION IN CARDIOMYOPATHIES AND PREDICTORS OF RECURRENCES

Abstract

Abstract Background Cardiac Sympathetic Denervation (CSD) has been recently proposed for the treatment of refractory ventricular arrhythmias (VAs) in patients with cardiomyopathy (CMP). Long–term outcome and predictors of recurrences after the procedure are still poorly defined. Aim: To describe our multicenter Italian experience with CSD in CMP patients with refractory VAs. Methods 32 patients with CMP and refractory VAs underwent either left CSD (n=4) or BCSD (n=28). All patients had a Video Assisted Thoracoscopic Surgery, in 8 cases with the robotic technique. The main reason (3/4 cases, 75%) to perform LCSD instead of BCSD was sinus bradycardia in single ICD lead recipients. Results 84% of patients were male, mean age was 55 ± 16 yrs and mean LVEF was 32± 12%; most (n=26, 81%) had non–ischemic CMP (including 3 with hypertrophic CMP and 2 with cardiolaminopathy) and 34% were in NYHA class ≥3. Main indications for CSD were refractory polymorphic/fast VAs (>200 bpm) in 56% of pts and refractory monomorphic VAs in the rest. Except for 5 patients (15%) with previous thyrotoxicosis, the majority were either on amiodarone (n=20, 63%) or on sotalol (n=3, 9%) and 53% had previously undergone ≥1 catheter ablation for VAs. The median follow–up (FU) after CSD was 16 months (IQR 5–45 months). No major complications occurred. Eleven patients (34%) either died during FU (n=8, 25%), mostly due to end–stage heart failure, or underwent heart transplant (n=3, 9%). After CSD, the percentage of patients with ES decreased from 78% to 40% (p<0.01), while patients with appropriate ICD shocks decreased from 100% to 62%. The mean number of ICD shocks was reduced from 6 (IQR 3–16) in the 6 months before CSD to 0 (IQR 0–2) in the 6 months after (p=0.001). Overall, 69% of patients experienced a 6–months reduction in ICD shocks ≥ 75%, 81% a reduction ≥ 50%. At the univariate Kaplan Meier survival analysis, NYHA class ≥ 3 (p<0.001), VT heart rate < 180 bpm (p=0.02) and left ventricular ejection fraction (LVEF) ≤ 25% (p=0.02) were associated with ICD shock recurrences. Conclusions Our case series of CSD in CMP represents the largest reported in Europe and the one with the longest follow–up. The occurrence of electrical storms was almost halved by CSD, and most patients had a reduction in ICD shocks at 6 months larger than 75%. Patients with better functional class, better LVEF and faster VAs benefited more from CSD, suggesting the opportunity of an earlier referral of these patients.