title: Endoscopic left sympathetic blockade in the treatment for dilated cardiomyopathy.
abstract: BACKGROUND
  The level of sympathetic nervous activity is a major determinant of prognosis in patients with heart failure.
  
  
  OBJECTIVE
  The purpose of this investigation was to perform a proof-of-principle trial of therapeutic endoscopic left thoracic sympathetic blockade in heart failure patients to assess safety and immediate effects.
  
  
  METHODS
  Fifteen patients with dilated cardiomyopathy and left ventricular ejection fraction (LVEF) < 40%, New York Heart Association functional class II or III, and heart rate > 65 bpm, despite either adequate betablocker use or intolerant to it, were enrolled. Ten patients underwent left infra-stellate ganglion plus T3-T4 interspinal space clipping through videothoracoscopy, while the other five patients were randomized to a control group.
  
  
  RESULTS
  None of the treated patients had any procedure-related adverse cardiovascular events at the perioperative period. Two patients from the surgical group died due to pulmonary thromboembolism or myocardial infarction within 6 months of the initial follow-up, while three patients from the control group had heart failure progression and died or developed cardiogenic shock during the same period. Treated patients presented improvement in quality of life, level of physical activity and LVEF (from 25 ± 9% to 32 ± 8%, p=0.024) at 6 months of follow-up, whereas these parameters did not change in control patients.
  
  
  CONCLUSIONS
  Endoscopic left thoracic sympathetic blockade is feasible and appears to be safe in severe heart failure patients. This initial study suggests that this procedure might be an effective alternative approach to sympathetic blockade in the treatment of dilated cardiomyopathies.
authors.affiliation: Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: Luiz Felipe P
authors.initials: LF
authors.lastname: Moreira
authors.forename: Germano Emílio C
authors.initials: GE
authors.lastname: Souza
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
authors.forename: Noedir Antônio G
authors.initials: NA
authors.lastname: Stolf
authors.forename: Fábio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D001340:Autonomic Nerve Block / Q000379:methods*; D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013233:Stellate Ganglion / Q000601:surgery*; D013318:Stroke Volume / Q000502:physiology; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D013564:Sympathetic Nervous System / Q000503:physiopathology; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology