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

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.

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.

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).

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