Article

P1841Left cardiac sympathetic denervation in patients with long QT syndrome and catecholaminergic polymorphic ventricular tachychardia: a systematic review and meta-regression

Authors:
P Lopez Ayala
P Lopez Ayala
P Lopez Ayala
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A Sgro
A Sgro
A Sgro
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T M Drake
T M Drake
T M Drake
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K Phan
K Phan
K Phan
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Abstract

Background The evidence of benefit and safety of open surgery or Video-Assisted Thoracoscopic Surgery (VATS) for Left Cardiac Sympathetic Denervation (LCSD), for the management of patients with refractory Long QT Syndrome (LQTS) and Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), is not consistent. Purpose To undertake a systematic review and meta-regression to assess the current evidence for LCSD and to estimate the effects of the open surgery versus the VATS approach on outcomes following LCSD. Methods Databases (MEDLINE, EMBASE and Cochrane library) were searched without language or date restriction, from inception to December 2018, for studies reporting the long-term outcomes of LCSD in LQTS and CPVT patients. The number of patients experiencing cardiac events (CEs) before and after surgery, the change in QTc interval in milliseconds (ms), and the incidence of CEs and surgical complications after surgery were pooled to estimate the efficacy of LCSD in both LQTS and CPVT. A meta-regression analysis of outcomes based on the type of surgical approach (open vs VATS) was performed. Results Of 557 potentially relevant studies, 27 retrospective case series studies met our inclusion criteria, enrolling 647 patients (VATS, n=408 and Open, n=239). Average follow-up was 32 months. At the end of the follow-up period, 398/585 patients (68.0%) were free of CEs and QTc had decreased from 522±61.6 ms to 494±52.3 ms. Meta-regression analysis (14 studies, n=507) showed no differences between the two approaches in patients' responsiveness to surgery and the incidence of CEs or surgical complications. Open surgery had a statistically significant greater reduction in QTc duration than VATS (β −20.04, 95% CI −36.82 to −3.27, *p=0.019). Conclusions LCSD was associated with a reduction in the incidence of cardiac events in LQTS and CPVT patients and in the duration of QTc. Meta-regression analysis showed open surgery to be associated with a greater reduction in QTc. Higher evidence research studies are warranted to fully establish the safety and efficacy of LCSD. Acknowledgement/Funding None

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... LCSD was first described by Moss in 1969, as an alternative therapy in patients who are symptomatic despite on beta-blockers/contraindication for them, or ICD cannot be considered in controlling the VT storms. [7] LCSD can also be used as primary prevention when drug compliance is poor. LCSD apart from eliminating the triggers due to sympathetic activation and also modifies the arrhythmogenic substrate by QT interval shortening. ...
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