Surgical Cardiac Sympathetic Denervation

Bilateral surgical cardiac sympathetic denervation reduces ventricular arrhythmias by more than 60% in patients refractory to all available treatments including maximal beta-blockade. Bilateral surgical denervation is more effective than left-sided denervation alone. In a small randomised trial of myocardial infarction patients with ventricular arrhythmias, sudden cardiac death occurred in 21% of controls versus 3.6% with cardiac sympathetic denervation over 22 months. Off-site neurological effects are the most common surgical complication, with altered sensation, temperature regulation, or sweating reported in up to 70% of patients. Surgical cardiac sympathetic denervation is guideline-endorsed for sudden cardiac death prevention in long QT syndrome and catecholaminergic polymorphic ventricular tachycardia with a recommendation level similar to ICD implantation.