Document Detail


Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome.
MedLine Citation:
PMID:  15051644     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The management of long-QT syndrome (LQTS) patients who continue to have cardiac events (CEs) despite beta-blockers is complex. We assessed the long-term efficacy of left cardiac sympathetic denervation (LCSD) in a group of high-risk patients. METHODS AND RESULTS: We identified 147 LQTS patients who underwent LCSD. Their QT interval was very prolonged (QTc, 543+/-65 ms); 99% were symptomatic; 48% had a cardiac arrest; and 75% of those treated with beta-blockers remained symptomatic. The average follow-up periods between first CE and LCSD and post-LCSD were 4.6 and 7.8 years, respectively. After LCSD, 46% remained asymptomatic. Syncope occurred in 31%, aborted cardiac arrest in 16%, and sudden death in 7%. The mean yearly number of CEs per patient dropped by 91% (P<0.001). Among 74 patients with only syncope before LCSD, all types of CEs decreased significantly as in the entire group, and a post-LCSD QTc <500 ms predicted very low risk. The percentage of patients with >5 CEs declined from 55% to 8% (P<0.001). In 5 patients with preoperative implantable defibrillator and multiple discharges, the post-LCSD count of shocks decreased by 95% (P=0.02) from a median number of 25 to 0 per patient. Among 51 genotyped patients, LCSD appeared more effective in LQT1 and LQT3 patients. CONCLUSIONS: LCSD is associated with a significant reduction in the incidence of aborted cardiac arrest and syncope in high-risk LQTS patients when compared with pre-LCSD events. However, LCSD is not entirely effective in preventing cardiac events including sudden cardiac death during long-term follow-up. LCSD should be considered in patients with recurrent syncope despite beta-blockade and in patients who experience arrhythmia storms with an implanted defibrillator.
Authors:
Peter J Schwartz; Silvia G Priori; Marina Cerrone; Carla Spazzolini; Attilio Odero; Carlo Napolitano; Raffaella Bloise; Gaetano M De Ferrari; Catherine Klersy; Arthur J Moss; Wojciech Zareba; Jennifer L Robinson; W Jackson Hall; Paul A Brink; Lauri Toivonen; Andrew E Epstein; Cuilan Li; Dayi Hu
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2004-03-29
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Apr 
Date Detail:
Created Date:  2004-04-20     Completed Date:  2004-08-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1826-33     Citation Subset:  AIM; IM    
Affiliation:
Department of Lung, Blood and Heart, University of Pavia, Pavia, Italy. PJQT@compuserve.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Electrocardiography
Follow-Up Studies
Ganglionectomy
Genotype
Heart / innervation
Humans
Long QT Syndrome / diagnosis,  mortality,  surgery*
Male
Risk Factors
Sympathectomy*
Grant Support
ID/Acronym/Agency:
HL-33843/HL/NHLBI NIH HHS; HL-68880/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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