The Utility of Surgical Cardiac Sympathetic Denervation in the Management of Ventricular Arrhythmias for all Etiologies: A Systematic Review

Background: The antiadrenergic and antifibrillatory effects of cardiac sympathectomy in pathological states such as long QT syndrome are well established. The indications for the procedure have expanded since the videoassisted thoracoscopic approach was first used. However, the procedure is currently largely used in cases where medication has failed to prevent recurrence of symptomatic ventricular arrhythmia, or in cases of medication intolerance, and large randomised controlled trials are thus non-existent in the literature. The aim of this study was to perform a systematic review of the available literature to examine the utility of cardiac denervation in the management of all ventricular arrhythmias. Methods: A total of 17 studies published between 2009 and 2019 were evaluated for bias using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool. In addition the Harbour and Miller Grading System (2001) was used to assess the significance of the evidence in this review. Results: All studies demonstrated a protective effect of sympathectomy against ventricular arrhythmias in both primary and secondary prevention strategies. The following risk of bias was observed: low in 5 studies, moderate in 8 studies, and serious risk in 4 studies. The highest level of evidence observed was 2++ in 3 studies. Conclusion: Cardiac sympathetic denervation provides benefit for patients with ventricular arrhythmias, in cases of refractory disease or in patients who require a primary prevention strategy where first-line therapies are not tolerated.