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

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.