Cardiac sympathetic denervation to prevent life-threatening arrhythmias

After initial reports of the successful treatment of patients with angina, left cardiac sympathetic denervation (LCSD) entered clinical practice in the 1970s for patients with long QT syndrome (LQTS)LCSD prevents arrhythmias of ischaemic origin, raises the threshold for ventricular fibrillation (VF), does not induce postdenervation supersensitivity, improves the capacity of coronary arteries to dilate, and preserves cardiac contractilityThe different effects of LCSD versus right cardiac sympathetic denervation are explained by the fact that the left-sided cardiac sympathetic nerves are quantitatively dominant at the ventricular levelLCSD has proved to be highly effective in preventing life-threatening cardiac arrhythmias in patients with LQTS, catecholaminergic polymorphic ventricular tachycardia, or those at high cardiovascular risk after myocardial infarctionPreliminary data, and important effects on VF threshold, suggest that LCSD might be useful in many conditions characterized by high risk of life-threatening arrhythmias, including ischaemic, dilated, and hypertrophic cardiomyopathyCardiologists should discuss the advantages and disadvantages of LCSD compared with those of an implantable cardioverter–defibrillator with all patients, particularly children, who are at risk of arrhythmic sudden death