Outcome Of Patients With Systolic Heart Failure Undergoing Cardiac Sympathetic Denervation For Ventricular Arrhythmia

Abstract

<h3>Introduction</h3> Cardiac sympathetic denervation (CSD) is a surgical procedure increasingly used for the management of ventricular arrhythmia refractory to conventional medical therapy. Long term outcomes of CSD in patients with systolic heart failure has not been well studied. <h3>Hypothesis</h3> We aim to evaluate the medical comorbidities and outcomes of patients with systolic heart failure who undergo CSD performed as a treatment for ventricular arrhythmia refractory to conventional medical therapy. <h3>Methods</h3> We performed a retrospective analysis of 32 adult patients with ventricular arrhythmia and systolic heart failure who underwent either unilateral or bilateral CSD at the University of Florida from June 1, 2011 to March 31, 2021. Data was analyzed using SAS version 9.4 (SAS Institute, Cary, NC, USA), and unadjusted Kaplan-Meier curves were constructed over one year to evaluate survival over time in patients after CSD. <h3>Results</h3> Of the 32 patients, 28 (88%) were male. The mean age and mean LVEF at the time of CSD were 62 ± 11.6 years and 22 ± 8.2%, respectively. 40.6% of patients had a history of obstructive CAD, defined as at least one major coronary artery with ≥70% luminal stenosis or a history of PCI or CABG. The most common comorbid condition was hypertension (87.5%), followed by atrial arrhythmia (71.9%) and CKD (59.4%). The mean length of survival for all patients after CSD was 613 ± 742 days. At the end of the study period, 16 (50%) patients had died, and the mean time from CSD to death was 290 ± 446 days. The cumulative probability of survival one year after CSD was 71.2% (Figure 1). In a subgroup analysis of patients with and without obstructive CAD, there was a numerical trend towards improved survival in patients without obstructive CAD that was not statistically significant (<i>p</i>=.08). No significant difference in one-year survival was identified when patients were stratified by LVEF ≥20% versus <20% (<i>p</i>=.77). <h3>Conclusions</h3> In this single center retrospective study, CSD for refractory ventricular arrhythmia showed favorable survival (29% one-year cumulative mortality) in patients with systolic heart failure. Interestingly, we noted a trend towards survival in a subgroup of patients without obstructive CAD, and having an LVEF ≥20% did not provide any survival benefit after CSD compared to lower LVEF. The limitations to our study were a small sample size and a lack of follow-up in several patients despite no reported death. This study lays the groundwork for a more in-depth analysis of the potential survival benefits of CSD in patients with systolic heart failure.