left cardiac sympathetic denervation for patients with malignant

LEFT CARDIAC SYMPATHETIC DENERVATION FOR PATIENTS WITH
MALIGNANT VENTRICULAR TACHYCARDIA IN CHAGAS DISEASE PRELIMINARY RESULTS OF DESERT STUDY
Marcus V Santos; DESERT Investigators; Luiz Leite, Paula Macedo, Pedro Paniagua, Humberto
Oliveira, Simone Santos, Gustavo Moscardi, José Calegaro, Danielle Landa, Gustavo Gomes, Tamer
Seixas, Edna Marques, José Barreto, Bruno Silva, Benhur Henz, Hosp de Base-DF, Brasilia, Brazil
Introduction: Appropriated therapy (ICD-Shok) is an independet predictor of poor prognostic in pacient
with Chronic Chagas Disease (CCD) and ICD. Imbalance in autonomic nerve system has been linked to
the trigger of VT in Chagasic patients. Cardiac Sympathetic Blockade through surgical denervation of
left chain (LCSD) has been shown to be useful in patients with long QT syndrome, but has not been
tested in patients with VT and CCD. DESERT is a prospective randomized study for patients with
drug-refractory ICD-Shock due to malignant VT/VF.
Methods: Patients with Chagas Disease and at least 2 appropriated ICD shocks during the last month on
amiodarone (at least 400 mg/day), beta-blockers, and ACE therapy were allocated to undergo LCSD.
All patients underwent echocardiography, Holter monitoring, ECG and myocardial scintigraphy with
I23I-mIBG before and after procedure. LCSD were performed either by intervention on the first
thoracic ganglion (stellate) beyond the second, third and fourth thoracic ganglia. Patients were
followed-up at 30-days interval, and per protocol, no change in the ICD program or medication was
allowed. The protocol was approved by local ethic committee.
Results: In this preliminary data we report the results of the first 5 patients with at least 6 months of
follow-up (57y-o, 4 men, NYHA=2.2, LVEF=0.31). The mean appropriated therapy before LCSD was
28.6 (6.6 shocks and 23 ATP). After LCSD the mean appropriated therapy was 1.8 (p<0.001) in 2
patients. Three patients showed no ICD therapy. One patient had 2 ATP only in the first month after
procedure. Importantly, no ICD shocks were noted during follow-up. There was no complication. Also,
there was a significant reduction in total ventricular arrhythmias (VT/VF/PVC/h) before versus after
LCSD (p<0.001).
Conclusion: In this preliminary study, Video-assisted LCSD showed to be a promising therapy for
drug-refractory ventricular arrhythmias in Chagas disease.