Premium
Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study
Author(s) -
ConceiçãoSouza Germano Emílio,
PêgoFernandes Paulo Manuel,
Cruz Fatima das Dores,
Guimarães Guilherme Veiga,
Bacal Fernando,
Vieira Marcelo Luiz Campos,
Grupi Cesar José,
Giorgi Maria Clementina Pinto,
ConsolimColombo Fernanda Marciano,
Negrão Carlos Eduardo,
Rondon Maria Urbana P.,
Moreira Luiz Felipe Pinho,
Bocchi Edimar Alcides
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs132
Subject(s) - medicine , heart failure , ejection fraction , cardiology , clinical endpoint , heart rate , quality of life (healthcare) , sinus rhythm , blood pressure , randomized controlled trial , atrial fibrillation , nursing
Aims To evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. Methods and results In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) ≤40%, sinus rhythm, and resting heart rate >65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow‐up and morbidity according to pre‐specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long‐term follow‐up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 ± 6.6 to 33 ± 5.2 ( P = 0.03); 6 min walking distance improved from 167 ± 35 to 198 ± 47 m ( P = 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 ± 5 to 15 ± 7 ( P = 0.06). The remaining analysed variables were unchanged. During 848 ± 549 days of follow‐up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. Conclusions LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration : NCT01224899.