Original-clinicalGenetic: Editorial commentaryCutting nerves and saving lives
Section snippets
Nothing new under the sun
LCSD is not a novel therapy. In this era of PubMed, people tend to ignore previous research, when “previous” means more than 30 to 40 years ago. The report by Collura et al amplifies a concept that has been present even in the recent cardiologic literature, but it may be useful to revisit how LCSD really started, developed, almost disappeared, and eventually was resurrected.
In 1899, Francois-Frank,15 who was studying the transmission of sensory information from the aorta through the
Understanding the implications
Collura et al14 report on 20 patients (18 with LQTS and 2 with CPVT) in whom LCSD was performed for primary and secondary prevention of life-threatening arrhythmias. Except for two cases operated on according to traditional surgery,37, 38 in the remaining 18 patients LCSD was performed by video-assisted thoracic surgery (VATS). The results were very successful. Especially impressive are the cases of patients whose tachyarrhythmias could be prevented by only continuous infusion of lidocaine and
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Cited by (48)
Left Cardiac Sympathetic Denervation for Long QT Syndrome: 50 Years’ Experience Provides Guidance for Management
2022, JACC: Clinical ElectrophysiologyCitation Excerpt :The recognition of the heterogeneity of patients with LQTS, based on their specific history (events in the first year of life, or not), on their specific ECG (QTc < 500 ms or ≥500 ms), on their specific LQTS-causing genes, now allows to decide when to use LCSD, when to use it in addition to BBs or as a complement to an ICD (to reduce the probability of shocks while having the ICD as a safety net). Even a relatively gross intervention such as cutting nerves to prevent lethal arrhythmias (52) can now enter the “precision medicine” era (22). COMPETENCY IN MEDICAL KNOWLEDGE: LCSD provides a clear and long-term antifibrillatory protection in patients with LQTS.
Strategies for prevention and management of QT interval prolongation and torsades de pointes
2022, Torsades de PointesLong QT Syndrome: A Comprehensive Review of the Literature and Current Evidence
2019, Current Problems in CardiologyCitation Excerpt :It is used in patients in whom ICD therapy is refused or contraindicated or in people in whom beta blockers are nor tolerated or effective.55-57 Studies have shown that they are equally as effective as ICD.55 One study showed comorbidities associated with LCSD were lower as compared to ICD implantation alone.46
Rationale and design of a prospective study to assess the effect of left cardiac sympathetic denervation in chronic heart failure
2017, International Journal of CardiologyCitation Excerpt :Pharmacological therapy such as β-blockers can modulate the autonomic nervous system and can reduce mortality, morbidity and sudden death in patients with heart failure [9]. Left cardiac sympathetic denervation (LCSD), a surgical procedure that removes the quantitatively dominant left-sided cardiac sympathetic innervation to the heart, prevents release of norepinephrine at ventricular level and is associated with a significant antifibrillatory effect [10–13]. This is performed by surgically removing the lower half of the left stellate ganglion together with the first 3–4 thoracic ganglia, thus avoiding the Horner's syndrome.