Bilateral Cardiac Sympathetic Denervation Research Articles

Outcome of Patients With Systolic Heart Failure Who Underwent Sympathectomy for Ventricular Arrhythmia

Cardiac sympathetic denervation (CSD) is a surgical procedure increasingly used for managing ventricular arrhythmia refractory to conventional medical therapy. Long-term outcomes of CSD in patients with systolic heart failure has not been well studied. This observational study aimed to evaluate the medical co-morbidities and outcomes of patients with systolic heart failure who underwent CSD performed as treatment for ventricular arrhythmia refractory to conventional therapy. A retrospective analysis in adult patients with ventricular arrhythmia and systolic heart failure who underwent unilateral or bilateral CSD at a single center was performed. Unadjusted Kaplan-Meier survival curves were constructed to evaluate survival after CSD. Between June 1, 2011 and March 31, 2021, 32 adult patients (age 62 ± 11.6 years, 88% male, left ventricular ejection fraction 22% ± 8.2%) with systolic heart failure underwent unilateral left (n = 4), unilateral right (n = 1), or bilateral CSD (n = 27). Mean survival after CSD was 613 ± 745 days, and the mean time from CSD to death was 291 ± 447 days. The cumulative probability of survival 1 year after CSD was 61.4%. In this single-center observational study, CSD performed for refractory ventricular arrhythmia showed favorable survival in patients with systolic heart failure. In conclusion, this study lays the groundwork for a more in-depth analysis of the potential survival benefits of CSD in this patient group.

Bilateral thoracic sympathectomy for refractory coronary artery spasm—A case report

Abstract A 51-year-old woman was admitted because of three-degree AV block. Serial coronary angiogram revealed right coronary artery spasm, which is refractory to drug eluting stents and Nitroglycerin infusion. She underwent bilateral cardiac sympathetic denervation with video-assisted thoracoscopic surgery and was discharged on day 26 asymptomatically. Bilateral cardiac sympathetic denervation could be used for patients with symptomatic coronary artery spasm.

Modified sympathicotomy in patients with refractory ventricular tachycardia and structural heart disease: a single-center experience.

Modified cardiac sympathetic denervation (CSD) with stellate ganglion (SG) sparing is a novel technique for cardiac neuromodulation in patients with refractory ventricular tachycardia (VT). Our aim is to describe the mid- to long-term clinical outcome of the modified CSD with SG sparing in a series of patients with structural heart disease (SHD) and refractory VT. All consecutive patients with SHD and refractory VT undergoing modified CSD were enrolled. Baseline clinical characteristics and periprocedural data were collected for all patients. The primary outcome was any recurrence of sustained VT. We enrolled 15 patients (age: 69.2 ± 7.9years; male 100%) undergoing modified CSD. Left ventricular ejection fraction was 37 ± 11% and all patients had an implantable cardiac defibrillator (ICD); the underlying cardiomyopathy was non-ischemic in 73.3% of them. At least one previous ablation had been attempted in 66.6% of cases. The 73.3% of patients underwent bilateral CSD and the mean effective surgical time was 10.8 ± 2.4min per side; no major periprocedural complication occurred. After a median follow-up time of 15months (IQR: 8.5-24.5months), the primary outcome occurred in 47.6% of cases. All patients experienced a reduction of ICD shocks after CSD (3.1 ICD shocks/patient before vs. 0.3 ICD shocks/patient after CSD; p-value: 0.001). Bilateral CSD and a VT cycle length < 340ms were associated with better outcomes. A modified CSD approach with stellate ganglion sparing appears to be safe, fast, and effective in the treatment of patients with SHD and refractory VTs.

Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias.

The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45-65 years) and a median ejection fraction of 58.5% (IQR, 56.2%-60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. The median hospital stay after surgery was 2 days (IQR, 2-3 days). The median surgical time for BCSD was 113 minutes (IQR, 104-126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5-28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.

Robotic bilateral cardiac sympathetic denervation in a patient with severe long QT syndrome: First experience in Poland

Robotic bilateral cardiac sympathetic denervation in a patient with severe long QT syndrome: First experience in Poland

Bilateral cardiac sympathetic denervation in patients with congenital long QT syndrome

Long QT syndrome (LQTS) is a potentially lethal yet treatable genetic heart disease for which left cardiac sympathetic denervation (LCSD) is a class I recommendation. Recent reports have suggested bilateral cardiac sympathetic denervation (BiCSD) as the initial surgical denervation therapy in LQTS. The purpose of this study was to determine the frequency and settings in which BiCSD was used in a tertiary referral center with expertise in LCSD. We performed a retrospective review of 234 out of 1638 patients with LQTS who underwent sympathetic denervation (14%) at our institution to identify the subset of patients who underwent BiCSD. Cardiac events (CEs) before LCSD, after LCSD, and after the completion of BiCSD were recorded and defined as being an appropriate implantable cardioverter-defibrillator shock, arrhythmic syncope, or sudden cardiac arrest. Only 11 patients (4.7%; 6 females [55%]) had BiCSD at our institution. Patients who received BiCSD trended toward being younger at diagnosis (6 ± 15 years vs 14 ± 13 years; P = .06) and being more likely to be symptomatic (73% vs 53%; P = .07) than the larger LCSD-only cohort. Continued CEs post-LCSD (3.8 CEs per patient on average) was the predominant determinant to return for BiCSD. Over 60 combined years of follow-up, 4 patients have not had a CE post-BiCSD while the other 7 patients average 3.6 nonlethal CEs. Less than 5% of all patients receiving denervation therapy underwent BiCSD. When BiCSD was chosen, it was almost always done in a staged sequential manner beginning with LCSD first and when driven by the arrhythmogenicity of the LQTS substrate, despite otherwise optimized guideline-directed therapies.

Robotic bilateral cardiac sympathetic denervation in apatient with severe long QT syndrome: First experience in Poland.

Robotic bilateral cardiac sympathetic denervation in apatient with severe long QT syndrome: First experience in Poland.

Bilateral Cardiac Sympathetic Denervation for Treatment-Resistant Ventricular Arrhythmias in Heart Failure Patients with a Reduced Ejection Fraction.

The sympathetic nervous system plays an important role in life-threatening ventricular arrhythmias (VAs). Bilateral cardiac sympathetic denervation (BCSD) is performed for refractory VAs. We sought to assess our institutional experience with BCSD in managing treatment-resistant monomorphic ventricular tachycardia (MMVT) in heart failure patients with a reduced ejection fraction (HFrEF).Four patients with HFrEF (EF 30.0 ± 8.2%, New York Heart Association [NYHA] class IV 1) underwent BCSD for MMVT (VT storm 3, repetitive VT requiring implantable cardioverter defibrillator [ICD] therapy 1) refractory to antiarrhythmic drugs, catheter ablation and ICD therapy. BCSD was effective for suppressing VT in 3 patients for whom deep sedation was effective for suppressing VT. One patient remained alive after 14 months of follow-up without episodes of VT. One patient died of acute myocardial infarction before discharge and 1 patient died from unknown cause at 3 days post-discharge. In contrast, BCSD was completely ineffective for suppressing VT in a patient with NYHA class IV for whom deep sedation and stellate ganglion block were ineffective. This patient died on the 10th post-CSD day, despite left ventricular assist device implantation. In all cases, BCSD was successfully performed without procedure-related complications.Despite the limited number of cases, our results showed that BCSD in patients with HFrEF suppressed refractory MMVT in acute-phase except for a patient with NYHA class IV; however, the prognoses were not good. BCSD may be a treatment option at an earlier stage of NYHA and a bridge to orthotopic heart transplantation, even if BCSD is effective for suppressing VAs.

PO-637-07 EFFECT OF BILATERAL CARDIAC SYMPATHETIC DENERVATION ON EXERCISE TOLERANCE AND CARDIAC FUNCTION

Bilateral cardiac sympathetic denervation (BCSD) decreases sympathetic outflow to the heart and is used as a treatment strategy in patients with refractory ventricular arrhythmias. However, there has been concern regarding removal of bilateral sympathetic chains with regards to exercise endurance and cardiac inotropy, and hence, a left sided only procedure has been advocated.

Cardiac Sympathetic Denervation for the Management of Ventricular Arrhythmias.

The autonomic nervous system contributes to the pathogenesis of ventricular arrhythmias (VA). Though anti-arrhythmic drug therapy and catheter ablation are the mainstay of management of VAs, success may be limited in patients with more refractory arrhythmias. Sympathetic modulation is increasingly recognized as a valuable adjunct tool for managing VAs in patients with structural heart disease and inherited arrhythmias. In this review, we explore the role of the sympathetic nervous system and rationale for cardiac sympathetic denervation (CSD) in VAs and provide a disease-focused review of the utility of CSD for patients both with and without structural heart disease. We conclude that CSD is a reasonable therapeutic option for patients with VA, both with and without structural heart disease. Though not curative, many studies have demonstrated a significant reduction in the burden of VAs for the majority of patients undergoing the procedure. However, in patients with unilateral CSD and subsequent VA recurrence, complete bilateral CSD may provide long-lasting reprieve from VA.

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

<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.

Effectiveness of ultrasonography-guided cardiac sympathetic denervation in acute control of electrical storm: A retrospective case series.

Ultrasonography-guided left cardiac sympathetic denervation (LCSD) or bilateral cardiac sympathetic denervation (BCSD) may be a useful intervention in the electrical storm (ES) that persists despite pharmacological therapy. The aim of our study was to evaluate the effectiveness of ultrasonography-guided LCSD or BCSD in the acute control of ES. We conducted a retrospective case series of patients who underwent ultrasonography-guided CSD for control of ES at a tertiary care hospital. Data of all patients who underwent unilateral or bilateral CSD were collected from January 2017 to December 2019. Eleven patients with ES refractory to standard antiarrhythmic therapy underwent ultrasonography-guided pharmacological CSD (eight underwent LCSD and three underwent BCSD). Quantitative data was expressed as mean and median with interquartile range (IQR). Non-quantitative data was expressed in proportions. Eleven patients underwent ultrasonography-guided pharmacological CSD (eight underwent LCSD and three underwent BCSD). Six of the eleven patients were female (54.5%). Ischemia was the underlying substrate in nine patients (81.8%). Five patients (46%) had complete resolution of ventricular tachycardia (VT) after CSD and one had 90% reduction in episodes of VT. The median follow-up duration was 8 months inter-quartile range IQR (7-18). One patient succumbed to heart failure and one patient was lost to follow up. The other patients had no further events and were well at last follow up. Ultrasonography-guided pharmacological CSD is effective in the acute control of ES. It is easily performed with equipment that is readily available and relatively safe in terms of immediate complications and is an ideal second-line intervention when ES persists despite drug therapy.

Role of chronic continuous intravenous lidocaine in the clinical management of patients with malignant type 3 long QT syndrome.

Type 3 long QT syndrome (LQT3) is caused by pathogenic, gain-of-function variants in SCN5A leading to a prolonged action potential, ventricular ectopy, and torsades de pointes. Treatment options include pharmacotherapy, cardiac denervation, and/or device therapy. Rarely, patients with malignant LQT3 require cardiac transplantation. The purpose of this study was to evaluate the role of chronic continuous intravenous (IV) lidocaine as a therapeutic option for select patients with LQT3 refractory to standard therapy. We performed a retrospective review of patients evaluated and treated at Mayo Clinic and identified 4 of 161 patients with LQT3 (2.5%) who were refractory to standard therapies and therefore treated with IV lidocaine. There were 4 patients (2 female [50%]). The median age at first IV lidocaine infusion was 2 months (interquartile range 1.5-4.8 months), and the median cumulative duration on IV lidocaine was 11.5 months (interquartile range 8.7-17.8 months). The main indication for IV lidocaine in all patients was persistent ventricular arrhythmias. Before IV lidocaine, all patients received an implantable cardioverter-defibrillator, and while on intermittent IV lidocaine, all patients underwent bilateral cardiac sympathetic denervation. Additionally, 2 (50%) patients had cardiac ablation for premature ventricular complexes. In all patients, lidocaine infusion resulted in a significant reduction of LQT3-triggered cardiac events. The main side effects of IV lidocaine observed were dizziness (n= 2, 50%) and seizures (n = 2, 50%). During follow-up, 3 of 4 (75%) patients underwent orthotopic cardiac transplantation. The remaining patient continues to receive IV lidocaine bolus for rescue as needed. For patients with LQT3 who are refractory to standard treatment, chronic IV lidocaine infusion can be used as a potential "bridge to transplant."

Abstract 13833: Cardiac Sympathetic Denervation in Patients With Ventricular Tachycardia or Electrical Storm: A 6 Months Follow-Up

Introduction: Cardiac sympathetic denervation (CSD) is considered in the management of patients with refractory ventricular arrhythmias or storm. It has been shown to decrease the burden of ventricular arrhythmias and the ICD shocks acutely in previous studies, however, follow-up data is still limited. Hypothesis: The purpose of this study is to evaluate ventricular tachycardia (VT) recurrence within a 6-month period after CSD. Methods: We analyzed all patients who underwent CSD at the University of Florida hospital between 2011 to 2017. The primary outcome was the recurrence of sustained VT at 6 months. The burden of ICD shocks, the need for VT ablation/redo ablation, and cardiovascular-related mortality in the first 6 months were also reported. Results: A total of 29 patients with CSD were included (9 patients had left CSD and 20 patients had bilateral CSD, mean age 60.1±11.5, 86 % male, and EF 27.3±15.4% by 2D-echocardiography), 13 (44.8%) of them presented with VT storm and 15 (51.7%) had prior VT ablation. One patient had cardiovascular-related mortality by 1 month and 7 patients by 6 months. The rate of VT recurrence was 31% by 1 month and increased to 35% by 6 months. By the end of the follow-up period, 17 (58.6%) patients remained free of recurrent ICD shocks and VT ablation was needed in 12 (41.4%) patients, 6 of them were redo-ablations. We further divided patients based on the underlying heart disease including ischemic heart disease (HD) and non-ischemic HD and there was no difference in the rate of VT recurrence at 6 months (p=0.18). There was also no difference in the primary outcome between left only CSD and bilateral CSD (P=0.98). Conclusions: Our data show that CSD showed benefit in VT recurrence rate at 6 months post-procedure. Reduction and freedom of ICD shocks were noted in patients with refractory VT or electrical storm. These benefits were independent of the underlying heart disease etiology. More studies with a longer follow-up period are warranted to confirm these results and follow long-term outcomes.

Long-term outcome of patients with cardiolaminopathy undergoing defibrillator implantation: single-center experience

Abstract Background Mutations in the LMNA gene are associated with a high arrhythmic risk. The history of the disease in patients undergoing ICD implantation is poorly characterized. Purpose To evaluate the phenotype of patients with cardiolaminopathy at the time of first ICD implantation, the incidence, characteristics and timing of ventricular arrhythmias (VAs) during follow up and the predictive value of the European score (that assigns a point each to non-sustained VT (NSVT), left ventricular ejection fraction (LVEF)&amp;lt;45% at first contact, male sex and non-missense mutations) and of the Wahbi score (that also includes conduction disturbances) for both VAs and heart failure (HF) related outcomes. Methods Patients were identified retrospectively. Clinical and device data were collected at baseline and during follow-up. Results We identified 26 patients (54% male, 42±8 years, 31% with familial history of sudden cardiac death, 31% with non-missense mutation) undergoing ICD implantation, 96% in primary prevention, 47% with single chamber ICD, 38% with dual chamber ICD. At the time of implantation, 30% had skeletal muscle involvement, 15% history of syncope, 4% of cardiac arrest, 62% previous NSVT. Also, 38% had a history of supraventricular arrhythmias and 61% had AV conduction disturbances. LVEF was 41±11%, 35% were in NYHA class ≥2, the mean European and Wahbi scores were 2.1±0.8 and 18.2±8.9, respectively. During 8.3±5 years, 15% were transplanted, 8% died due to HF, 4% underwent LVAD implantation, despite 31% having received an upgrade to CRT-D. Appropriate device interventions occurred in 46% of patients with a median time to first event of 29 months (IQR 13–93), for a total of 137 ATP, 51% of which effective (median 3ATP/patient, IQR 1–8) and of 26 shocks, 96% of which effective (median 2 shocks/patient, IQR 1–3); 12% had an arrhythmic storm. The first treated arrhythmia was a polymorphic VT/VF in 17%, a monomorphic VT in the others (medium cycle length 293±37 msec). Survival free from appropriate ICD interventions at 1 and at 5 years was 75% and 19% respectively in case of a European score ≥3 vs 94% and 82% in case of a score &amp;lt;3 (Logrank test p&amp;lt;0.01), 72% and 46% in case of Wahbi score ≥30 vs 100% and 86% with score &amp;lt;30 (p&amp;lt;0.01), with no differences in terms of death/transplant (figure). At last follow-up, 92% of patients a were taking beta-blocker, 42% amiodarone, 8% sotalol, 4% flecainide, 8% mexiletine. Also, 4% had undergone invasive VT ablation, 8% bilateral cardiac sympathetic denervation. Conclusions Patients with cardiolaminopathy are at a high risk of both arrhythmic and heart failure progression over the first decade after implantation of the first ICD. A European score ≥3 identifies patients with 5-year shock/ATP free survival of less than 20% but does not predict death/transplantation. The first arrhythmic event in these patients is more frequently a rapid monomorphic VT with modest ATP efficacy. Funding Acknowledgement Type of funding sources: None.

Bilateral thoracoscopic sympathectomy for cardiac denervation in pediatric population: Does Kuntz nerve cauterization have an impact on success?

Cardiac sympathetic denervation (CSD) is an effective procedure for the treatment of inherited channelopathies. Left CSD has traditionally been recommended as neuromodulation to prevent arrhythmia episodes; however, it is thought that bilateral sympathectomy in combination with Kuntz ablation may have additional effects effective due to the anatomical variability of preganglionic sympathetic fibers. The aim of the study was to share our single-center clinical experience with bilateral thoracoscopic sympathectomy for cardiac denervation in different groups of pediatric patients with malignant arrhythmias. Fourteen patients (seven with CPVT, five with LQTS, one with resistant ventricular tachycardia as a sequela of myocarditis, and one with cardiomyopathy and atrial tachycardia) underwent bilateral thoracoscopic sympathectomy for cardiac denervation. In all patients, arrhythmia episodes persisted despite medical therapy, and patients with implantable cardioverter-defibrillator received appropriate therapies. The rate of appropriate therapies was 3.25 per year (1-5 per year) in the year before sympathectomy. No major complications related to the procedure were observed in any of the patients. The QTc interval of LQTS patients decreased from 506.2 ± 16.9 ms before the procedure to 476 ± 28.8 ms after the procedure. The mean duration of follow-up after the procedure was 23.3 months (11-47 months). Only two patients received single episodes of therapy 12 and 22 months after CSD, and one patient had arrhythmic events due to noncompliance to medical therapy. Due to the anatomical variability of preganglionic fibers bilateral CSD with Kuntz nerve ablation effective treatment and is a safe option.

Long-Term Outcomes of Bilateral Cardiac Sympathetic Denervation for Refractory Ventricular Tachycardia.

This study sought to explore the long-term arrhythmic outcomes of bilateral cardiac sympathetic denervation (BCSD). BCSD has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether BCSD antiarrhythmic effects are sustained long after the procedure is still uncertain. We included consecutive patients who underwent BCSD because of refractory ventricular tachycardia (VT) and had at least 18months of follow-up. VT recurrence after BCSD was evaluated to assess arrhythmic outcomes. The occurrence of VT episodes within the first 12weeks after the procedure was assessed to explore the impact of early VT recurrence on late arrhythmia-free survival. Twenty patients (42 ± 16 years; 55% male) were included in the analysis. Nineteen (95%) patients had structural heart disease (left ventricular ejection fraction: 0.46 ± 0.14). Class I or class III drugs failed for all patients, and the mean number of VT ablation procedures was 2.5 ± 1.6. Over a mean follow-up of 1,300 ± 321days (median: 1,276 days [Interquartile range (IQR): 1,181 to 1,480 days), 11 (55%) patients remained VT free after sympathectomy. Freedom from sustained VT or implantable cardioverter-defibrillator shock was 60% (95% confidence interval: 0.35 to 0.77) and 54.5% (95% confidence interval: 0.31 to 0.73) after BCSD at 1 and 4 years. Early VT recurrence was not associated with worse late arrhythmia-free survival rates. BCSD was associated with longstanding antiarrhythmic effects in patients with refractory ventricular arrhythmias. The occurrence of VT episodes early after the procedure was not associated with worse late arrhythmic outcomes.

Cardiac sympathetic denervation and mental health.

Bilateral cardiac sympathetic denervation (BCSD) is a surgical treatment for refractory ventricular arrhythmias. Although the procedure has shown efficacy at reducing cardiac arrhythmias, its impact on mental health is unknown. In the current study we examined associations between the BCSD procedure and mental health. 10 ventricular arrhythmia patients undergoing BCSD completed assessments of anxiety, depression, and posttraumatic stress symptoms at pre- and post-BCSD time points. Wilcoxon signed rank and Mann-Whitney U tests were used to examine differences in mental health symptoms in the pre- and post-BSCD states. Point biserial correlations were used to explore associations between BCSD response and mental health symptoms. A significant reduction of anxiety symptoms was observed from pre- to post-BCSD. At the post-BCSD assessment, participants who successfully responded to the BCSD procedure exhibited lower anxiety symptoms compared to non-responders. However, no significant relationships were identified for depressive or PTSD symptoms. The BCSD procedure is associated with reduced anxiety shortly after successful treatment for refractory ventricular arrhythmias in a small sample. Longitudinal surveillance of mental health symptoms after BCSD may be warranted to monitor the impact of this procedure on mental health.

Acute hemodynamics of cardiac sympathetic denervation

IntroductionWe aimed to study the immediate hemodynamic effects of thoracoscopic bilateral cardiac sympathetic denervation (CSD) for recurrent ventricular tachycardia (VT) or VT storm. MethodWe studied a group of 18 adults who underwent bilateral thoracoscopic CSD; the blood pressure (BP) and Heart Rate (HR) were continuously monitored during the surgery and up to 6 h post-operatively. ResultsImmediately on removal of the sympathetic ganglia, the patients had a drop in both the systolic (110 mm Hg to 95.8 mm Hg, p < 0.001) and diastolic BP (69.4 mm Hg to65 mm Hg, p = 0.007) along with a drop in the HR (81.6 bpm to 61.2 bpm, p < 0.001).At 6 h after CSD, the systolic and diastolic BP did not recover significantly, while there was recovery in HR (61.2 bpm to 66 bpm, p = 0.02). There was no significant difference between those with and without left ventricular (LV) systolic dysfunction. ConclusionThe acute hemodynamic changes during the perioperative period of CSD are significant but not serious. Awareness of this is useful for peri-operative management.

Bilateral cardiac sympathetic denervation in children with long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia

• Left cardiac sympathetic denervation is reported to reduce the rate of events in young patients with channelopathy. • Horner syndrome and recurrence can be seen after left cardiac sympatetic denervation. • Bilateral cardiac sympathetic denervation in pediatric patient, is reported as a case report. • Bilateral cardiac sympathetic denervation is a safe procedure which reduces recurrence in channelopathies.