|Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome|
|Schwartz, PJ; Priori, SG; Cerrone, M; Spazzolini, C; Odero, A; Napolitano, C; Bloise, R; De Ferrari, GM; Klersy, C; Moss, AJ; Zareba, W; Robinson, JL; Hall, WJ; Brink, PA; Toivonen, L; Epstein, AE; Li, CL; Hu, DY|
|关键词||death, sudden long-QT syndrome nervous system, sympathetic genetics|
|WOS标题词||Science & Technology|
|类目[WOS]||Cardiac & Cardiovascular Systems ; Peripheral Vascular Disease|
|研究领域[WOS]||Cardiovascular System & Cardiology|
|关键词[WOS]||DEATH ; THERAPY ; ARRHYTHMIAS ; STELLECTOMY ; PREVENTION ; MUTATIONS|
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 β-blockade and in patients who experience arrhythmia storms with an implanted defibrillator.
|作者单位||1.Univ Pavia, Dept Lung Blood & Heart, I-27100 Pavia, Italy|
2.IRCCS Fdn Maugeri, Pavia, Italy
3.Univ Rochester, Med Ctr, Dept Med, Rochester, NY 14642 USA
4.Tygerberg Hosp, Tygerberg, South Africa
5.Policlin San Matteo, IRCCS, Dept Cardiol, I-27100 Pavia, Italy
6.Univ Rochester, Med Ctr, Dept Biostat, Rochester, NY 14642 USA
7.Univ Alabama, Div Cardiovasc Dis, Birmingham, AL 35294 USA
8.Univ Stellenbosch, Dept Internal Med, ZA-7505 Tygerberg, South Africa
9.Univ Helsinki, Dept Med, Helsinki, Finland
10.Peking Univ, Peoples Hosp, Dept Cardiol, Beijing 100871, Peoples R China
|Schwartz, PJ,Priori, SG,Cerrone, M,et al. Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome[J]. CIRCULATION,2004,109(15):1826-1833.|
|APA||Schwartz, PJ.,Priori, SG.,Cerrone, M.,Spazzolini, C.,Odero, A.,...&Hu, DY.(2004).Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome.CIRCULATION,109(15),1826-1833.|
|MLA||Schwartz, PJ,et al."Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome".CIRCULATION 109.15(2004):1826-1833.|