title: Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study.
abstract: OBJECTIVE
  To evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients.
  
  
  RESULTS
  In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) ≤40%, sinus rhythm, and resting heart rate >65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 ± 6.6 to 33 ± 5.2 (P = 0.03); 6 min walking distance improved from 167 ± 35 to 198 ± 47 m (P = 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 ± 5 to 15 ± 7 (P = 0.06). The remaining analysed variables were unchanged. During 848 ± 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT.
  
  
  CONCLUSIONS
  LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
authors.affiliation: Heart Institute Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Germano Emílio
authors.initials: GE
authors.lastname: Conceição-Souza
authors.forename: Paulo Manuel
authors.initials: PM
authors.lastname: Pêgo-Fernandes
authors.forename: Fatima das Dores
authors.initials: Fd
authors.lastname: Cruz
authors.forename: Guilherme Veiga
authors.initials: GV
authors.lastname: Guimarães
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.forename: Marcelo Luiz Campos
authors.initials: ML
authors.lastname: Vieira
authors.forename: Cesar José
authors.initials: CJ
authors.lastname: Grupi
authors.forename: Maria Clementina Pinto
authors.initials: MC
authors.lastname: Giorgi
authors.forename: Fernanda Marciano
authors.initials: FM
authors.lastname: Consolim-Colombo
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Negrão
authors.forename: Maria Urbana P
authors.initials: MU
authors.lastname: Rondon
authors.forename: Luiz Felipe Pinho
authors.initials: LF
authors.lastname: Moreira
authors.forename: Edimar Alcides
authors.initials: EA
authors.lastname: Bocchi
mesh_terms: D000328:Adult; D000368:Aged; D023381:Endpoint Determination; D005260:Female; D054143:Heart Failure, Systolic / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance / Q000502:physiology; D010865:Pilot Projects; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate; D013562:Sympathectomy / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology