Prognostic Impact of Atrial Rhythm and Dimensions in Patients with Structural Heart Disease Undergoing Cardiac Sympathetic Denervation for Ventricular Arrhythmias

Background: Cardiac sympathetic denervation (CSD) is a promising treatment for patients with structural heart disease (SHD) and refractory ventricular tachyarrhythmias (VT). The prognostic impact of atrial arrhythmias (AAs) and left atrial volume index (LAVI) on CSD outcome is unknown, as is the effect of CSD on atrial rhythm. Objective: Assess the impact of AAs and LAVI on CSD outcome, as well as changes in atrial rhythm after CSD. Methods: Patients with SHD undergoing CSD for VTs were analyzed. Hazard models were built to assess predictors of sustained VT/ICD shocks and death/orthotopic heart transplant (OHT). Changes before versus after CSD were assessed on ICD, clinical and echocardiographic data. A drug index was devised to correct for medication use. Results: Between 2009 and 2018, 91 patients (56 ± 13 years, LVEF 34 ±14%, 47% with a history of AAs) underwent left (16%) or bilateral CSD: the median FU was 14 months (IQR 4-37). Using multivariable analysis, neither LAVI nor AAs were associated with ICD shock recurrences. LAVI was an independent predictor of death/OHT. AAs burden did not change after CSD, while the percentage of atrial pacing increased from a median of 28% to 72% (p <0.01). LV end-diastolic diameter mildly increased; however, sustained VT/ICD shocks were reduced. Conclusions: In patients with SHD undergoing CSD a history of AAs did not impact outcome, LAVI is associated with death/OHT occurrence. In the absence of changes in the drug index, AAs burden, already low at baseline, was unchanged after CSD, despite a mild progression of cardiomyopathy, while atrial pacing increased.