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Introduction <p>The role of the sympathetic nervous system in the initiation and continuation of ventricular tachyarrhythmias (VTA) is well established. However, whether CSD reduces implantable cardioverter-defibrillator (ICD) shocks and recurrent VTA is still uncertain.</p> Methods <p>A comprehensive literature search was performed at Medline and Embase until March 2023. The primary outcome was the rate of ICD shocks and VTA per patient-year in our pooled analysis of all included articles. Analyses were conducted using Comprehensive Meta-Analysis software.</p> Results <p>Initial search yielded 1324 scientific studies with a total of 15 studies fitting our inclusion criteria. ICD shocks at 1 year post-CSD revealed an event rate of 69.8% (95% CI, 56.4–80.4% with 50% heterogeneity) (I<sup>2</sup> statistic). ICD shocks at 6 months had an event rate of 59.1% (95% CI, 46.9–70.4%; 47 <i>I</i><sup>2</sup>). Analysis of our pooled studies showed that 64.3% of individuals achieved freedom from VTA at 1 year post-CSD (95% CI, 42.3–81.5%; 26% <i>I</i><sup>2</sup>), while 62.3% were free from recurrent VTA 6 months post-CSD (95% CI, 51.2–72.2%; 40% <i>I</i><sup>2</sup>). Time to mortality directly caused by recurrent VTA post-CSD was subdivided into short-term (0–30 days), intermediate-term (31–364 days), and long-term (≥ 365). Mortality for the short-term tertile was 8.9% (95% CI, 5.0–15.4%; 0% <i>I</i><sup>2</sup>), medium-term was 5.3% (95% CI, 2.4–11.3%; 0% <i>I</i><sup>2</sup>), and long-term 5.2% (95% CI, 2.4–10.9%; 0% <i>I</i><sup>2</sup>).</p> Conclusion <p>CSD seems to be promising as an acceptable treatment strategy for recurrent VTA refractory to traditional pharmacological or ablation therapy.</p> Graphical Abstract <p></p>

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The role of cardiac sympathetic denervation for ventricular arrhythmias: an updated systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年1月29日

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  • Daniel B. Hanna,
  • Ahmadreza Karimianpour,
  • Nicole Mamprejew,
  • Chris Fiechter,
  • Dhiran Verghese,
  • Viviana Navas,
  • Dinesh Sharma

摘要

Introduction

The role of the sympathetic nervous system in the initiation and continuation of ventricular tachyarrhythmias (VTA) is well established. However, whether CSD reduces implantable cardioverter-defibrillator (ICD) shocks and recurrent VTA is still uncertain.

Methods

A comprehensive literature search was performed at Medline and Embase until March 2023. The primary outcome was the rate of ICD shocks and VTA per patient-year in our pooled analysis of all included articles. Analyses were conducted using Comprehensive Meta-Analysis software.

Results

Initial search yielded 1324 scientific studies with a total of 15 studies fitting our inclusion criteria. ICD shocks at 1 year post-CSD revealed an event rate of 69.8% (95% CI, 56.4–80.4% with 50% heterogeneity) (I2 statistic). ICD shocks at 6 months had an event rate of 59.1% (95% CI, 46.9–70.4%; 47 I2). Analysis of our pooled studies showed that 64.3% of individuals achieved freedom from VTA at 1 year post-CSD (95% CI, 42.3–81.5%; 26% I2), while 62.3% were free from recurrent VTA 6 months post-CSD (95% CI, 51.2–72.2%; 40% I2). Time to mortality directly caused by recurrent VTA post-CSD was subdivided into short-term (0–30 days), intermediate-term (31–364 days), and long-term (≥ 365). Mortality for the short-term tertile was 8.9% (95% CI, 5.0–15.4%; 0% I2), medium-term was 5.3% (95% CI, 2.4–11.3%; 0% I2), and long-term 5.2% (95% CI, 2.4–10.9%; 0% I2).

Conclusion

CSD seems to be promising as an acceptable treatment strategy for recurrent VTA refractory to traditional pharmacological or ablation therapy.

Graphical Abstract