Association of dysautonomia with refractory ventricular tachyarrhythmia in patients requiring thoracoscopic surgical cardiac sympathetic denervation

Andrei Gurau; Dianela Perdomo; Hamza Khan; Kelsey Melinosky; Anna Chudnovets; Jacob Blum; Mahmoud Kutmah; Victor Yang; Albert Leng; Arjun Menta; Xiyu Zhao; Suguru Yamauchi; Kristen Rodgers; Kathryn Ecoff; Errol Bush; Andreas S Barth; Malcolm Brock; Frank Bosmans; Jinny S Ha

doi:10.1016/j.xjon.2024.11.020

Association of dysautonomia with refractory ventricular tachyarrhythmia in patients requiring thoracoscopic surgical cardiac sympathetic denervation

JTCVS Open. 2024 Dec 12:23:120-127. doi: 10.1016/j.xjon.2024.11.020. eCollection 2025 Feb.

Authors

Andrei Gurau¹, Dianela Perdomo¹, Hamza Khan², Kelsey Melinosky³, Anna Chudnovets⁴, Jacob Blum¹, Mahmoud Kutmah¹, Victor Yang¹, Albert Leng¹, Arjun Menta¹, Xiyu Zhao¹, Suguru Yamauchi^{1

5

6}, Kristen Rodgers¹, Kathryn Ecoff¹, Errol Bush¹, Andreas S Barth⁷, Malcolm Brock¹, Frank Bosmans^{8

9

10}, Jinny S Ha¹

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
² Valley Health System General Surgery Residency Program, Las Vegas, Nev.
³ Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Tex.
⁴ General Surgery Department, Charleston Area Medical Center, Charleston, WVa.
⁵ Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan.
⁶ International Collaborative Research Administration, Juntendo University School of Medicine, Tokyo, Japan.
⁷ Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Md.
⁸ Molecular Physiology and Neurophysics Group, Ghent University, Ghent, East Flanders, Belgium.
⁹ Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
¹⁰ Experimental Pharmacology Group (EFAR), Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium.

Abstract

Objective: Although cardiac sympathetic denervation (CSD) effectively manages refractory ventricular tachyarrhythmias (RVTs) in long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia, the link between dysautonomia and RVT from broader etiologies is understudied. We hypothesized that dysautonomia is linked to RVT regardless of etiology in patients requiring CSD. We aimed to determine whether these patients have a high burden of dysautonomia symptoms using the Composite Autonomic Symptom Score-31 (COMPASS-31).

Methods: COMPASS-31 surveys were administered to 37 patients with RVT who underwent CSD and 37 matched healthy controls. COMPASS-31 scores were compared using Mann-Whitney U tests. Comparisons were made between patients with and without structural heart disease, and multivariable regression identified predictors for COMPASS-31 scores and CSD response.

Results: Common operative indications were idiopathic ventricular arrhythmias (49%) and arrhythmogenic right ventricular cardiomyopathy (30%). Patients with RVT had significantly greater COMPASS-31 scores (median 25.3) compared with control patients (median 8.6, P < .001), with greater scores in the gastrointestinal, secretomotor, orthostasis, pupillomotor, and vasomotor domains. Sensitivity analysis confirmed these findings, showing significantly greater COMPASS-31 scores in cases versus controls (estimate: 14.5; 95% confidence interval, 9.2-19.8, P < .001). No differences were found between patients with and without structural heart disease, and no predictors for COMPASS-31 score were identified. One year post-CSD, 78.4% of patients remained free of implantable cardioverter-defibrillator shocks.

Conclusions: Dysautonomia symptoms are significantly associated with RVT requiring CSD, regardless of underlying etiology. This association, in the context of CSD efficacy in RVT across structural and nonstructural etiologies, highlights autonomic dysfunction as a common pathophysiologic link warranting further investigation.

Keywords: COMPASS-31; autonomic dysfunction; dysautonomia; refractory ventricular tachycardia; thoracic sympathectomy; ventricular arrhythmias.