Abstract 13872: Quantifying the Benefit of Cardiac Sympathetic Denervation in Patients With Monomorphic Ventricular Tachycardia Referred for Catheter Ablation: An Effect Size Analysis

IntroductionCardiac sympathetic denervation (CSD) has been suggested as a treatment option for patients with recurrent monomorphic ventricular tachyarrhythmias (MMVT) and structural heart disease (SHD). Yet, given lack of clinical trials, the extent that CSD modifies risk of VT recurrence has been difficult to quantify given greater comorbidities of patients undergoing CSD in retrospective studies.AimTo quantify effect of CSD on VT outcomes in patients referred for VT ablation.MethodsBaseline characteristics and outcomes in patients referred for ablation from 2004 to 2018 were analyzed. Cox and competing risk proportional hazard models were developed to adjust for risk of VT recurrence, death and transplantation after ablation based on baseline comorbidities. Expected (adjusted) outcome rates using these models were compared to the observed rates in a subgroup of patients who received CSD, using their pre-ablation characteristics, in order to quantify impact of CSD on VT outcomes.ResultsOutcomes data were available in 404 patients with SHD and MMVT who underwent ablation (64±13 yo, 76% NYHA class ≥ 2, EF 32±13%, 50% non-ischemic cardiomyopathy, NICM). Mean follow up was 18±24 mo after ablation and 22±24 mo after CSD. NYHA class, VT storm, >1 anti-arrhythmic drug, NICM were independently associated with risk of VT recurrence and ICD shock. In addition to these, EF and chronic kidney disease were associated with risk of death/transplantation. After VT ablation, 69 patients (57±13 yo, 88% NYHA class ≥ 2, EF 34±12%, 83% NICM) received CSD (19% left CSD). Adjusted for pre-ablation comorbidities, expected hazard ratios (HRs) for recurrence and shock were 1.54 and 1.60 in the CSD population, while observed HRs were 1.05 and 1.08 after CSD, respectively. CSD modified risk of VT recurrence by 32% (observed/expected HR 0.68, p