TY  - EJOU
AU  - Sgrò, Alessandro 
AU  - Drake, Thomas M. 
AU  - Lopez‐Ayala, Pedro 
AU  - Phan, Kevin 

TI  - Left cardiac sympathetic denervation in the management of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia: A meta‐regression
T2  - Structural and Congenital Heart Disease

PY  - 2019
VL  - 14
IS  - 6
SN  - 3071-1738

AB  - <b>Background:</b> Left cardiac sympathetic denervation (LCSD) has been proposed as 
useful therapy for long QT syndrome (LQTS) and catecholaminergic polymorphic 
ventricular tachycardia (CPVT), in addition to anti‐arrhythmic agents and implant‐
able cardioverter defibrillators. This study aimed to assess the current evidence for 
LCSD and compare the open vs the video‐assisted thoracoscopic surgery (VATS) 
approaches.<br/>
<b>Methods:</b> MEDLINE, Embase and Cochrane library databases were searched up to 
December 2018 for studies reporting the long‐term outcomes of LCSD in LQTS, 
CPVT patients. The incidence of cardiac events (CEs) before and after surgery, the 
change in QTc interval, and surgical complications were pooled to estimate the effi‐
cacy of LCSD. Meta‐regression was used to estimate the effects of surgical approach 
(open vs VATS) on outcomes following LCSD.<br/>
<b>Results:</b> Twenty‐seven papers met our inclusion criteria (647 patients). VATS was 
used in 408 patients (63.1%), open surgery in 239 (36.9%). Mean follow‐up was 
32.3 ± 32.5 months. Postsurgery, 398/585 patients (68.0%) were free of CEs and 
QTc decreased from 522 ± 61.6 ms to 494 ± 52.3 ms. Meta‐regression showed no 
differences between the two approaches in the incidence of CEs and surgical compli‐
cations. VATS was associated with a smaller reduction in QTc (β‐coefficient −20.04, 
95% CI −36.82 to −3.27, P = .019).<br/>
<b>Conclusions:</b> LCSD was associated with a reduction in the incidence of CEs in LQTS, 
CPVT patients and in the duration of QTc. Open surgery was associated with a greater 
reduction in QTc. Due to the limitations that hindered our study, a randomized trial is 
warranted to fully establish LCSD safety and efficacy.
KW  - CPVT
KW  -  long QT syndrome
KW  -  sudden cardiac death
KW  -  sympathectomy
KW  -  VATS

DO  - 10.1111/chd.12855