Left cardiac sympathetic denervation (LCSD) is a surgical procedure that reduces the sympathetic (adrenaline-driven) nerve supply to the heart by removing the lower portion of the left stellate ganglion and the first four thoracic ganglia on the left side. By reducing the heart’s response to adrenaline and catecholamines, LCSD has a powerful antiarrhythmic effect, particularly in conditions where arrhythmias are triggered by adrenergic stimulation.
LCSD is most commonly used in the management of inherited channelopathies, particularly Long QT syndrome (especially LQT1 and LQT2), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome, where beta-blockers and ICD alone are insufficient to prevent breakthrough arrhythmias. It is also used in some patients with ischaemic heart disease and refractory ventricular tachycardia. The mechanism involves both reducing catecholamine levels at the heart and modulating the threshold for arrhythmia generation.
The procedure is performed as a minimally invasive video-assisted thoracoscopic surgery (VATS) under general anaesthesia. Recovery is typically quick and patients are usually discharged within one to two days. In appropriate patients, LCSD achieves a substantial reduction in arrhythmic burden and ICD shock frequency. It is complementary to (not a replacement for) an ICD in high-risk patients.
LCSD is performed at a small number of specialist centres in the UK. Referral is through the inherited cardiac conditions service when other treatments have been insufficient to control arrhythmia burden. The procedure has a favourable long-term outcome in appropriately selected patients.
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