Case report: surgical total cardiac denervation for refractory vasospastic angina: first report with pre- and post-operative autonomic assessment

Refractory vasospastic angina (VSA) can persist despite maximal medical therapy and partial autonomic denervation. Surgical total cardiac denervation (STCD) is a novel surgical approach resulting in disappearance of the anginal pain perception.

We report the first clinically successful STCD supported by objective pre- and post-operative autonomic assessment using heart rate variability (HRV) and iodine-123 metaiodobenzylguanidine (¹²³I-MIBG) scintigraphy. A 53-year-old woman with severe treatment-refractory VSA remained highly symptomatic. Pre-operative HRV and ¹²³I-MIBG both demonstrated preserved autonomic innervation. Following STCD, anginal symptoms resolved and ST-T segment changes became painless. Concomitantly, HRV markedly decreased and ¹²³I-MIBG showed significantly reduced tracer uptake, confirming complete sympathetic denervation. After a 9-month follow-up, the patient remains free of symptoms.

We present the first proof-of-concept case of STCD as a novel approach for refractory VSA. Further experience is required to evaluate broader efficacy, as well as long-term durability and safety.