LAUSR

BACKGROUND Cardiac sympathetic denervation (CSD) is an important adjunctive option for patients with refractory ventricular arrhythmias (VAs). Reports of efficacy of CSD in patients with structural heart disease (SHD) and refractory VA vary widely in literature. OBJECTIVE To conduct a systematic review of arrhythmic outcomes and complications in patients with SHD who underwent CSD due to recurrent VAs. METHODS Electronic databases (Google Scholar and PubMed) were searched to identify reports on CSD in SHD using appropriate medical subject terms. No sample size restriction was applied. All patients with known channelopathies were excluded. Baseline demographic and surgical data, arrhythmic outcomes, and procedural complications were evaluated. RESULTS A total of 13 studies and 173 patients were included. Out of 173 patients (121 [70%] male); pooled mean age 54.6 [95% CI: 52.6-56.7]), 48 (28%) had ischemic cardiomyopathy, and 141 (82%) underwent bilateral CSD. Overall freedom from events ranged from 58% to 100%. Complications were reported in 49 (28%) patients. Transient hypotension (9%), pneumothorax (5%), neuropathic pain (skin sensitivity) (4%), Horner's syndrome (3%), sweating pattern changes (3%) and hemothorax (2%) were the most common complications. No procedure related deaths were reported. CONCLUSION CSD reduced the number of VA events in patients with SHD, and the benefit from the intervention appeared to be independent of the underlying SHD. Although overall rate of post-procedure complications was high, most of them were temporary. Major post-procedural complications after CSD were infrequent.