Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery

Bloqueio simpático esquerdo por videotoracoscopia no tratamento da cardiomiopatia dilatada

“…The clinical use of sympatholytic agents such moxonidine was terminated prematurely due to increased mortality 13 and higher reductions in plasma norepinephrine concentrations after beta-blocker therapy were also related to higher mortality rates in the Beta Blocker Evaluation of Survival Trial (BEST) subgroup analysis 20 . Also in favor of the isolated left sympathetic blockade is the fact that this procedure has been successfully performed for the treatment of long QT syndrome 6 and catecholaminergic polymorphic ventricular tachycardia 7 . In this regard, left unilateral stellectomy is responsible for an increase in the ventricular refractory period similar to that obtained with the bilateral resection of stellate ganglion, whereas the isolated right stellectomy can produce a paradoxical decrease in refractoriness 11 .…”

“…Nevertheless, no procedure-related adverse events were observed in this initial trial and the intra-operative monitoring showed only a slight decrease in the peripheral vascular resistance without any period of hypotension, making it possible to perform the procedure in a more conventional and comprehensive way. The resection or cauterization of the sympathetic chain can be potentially performed in heart failure patients without any adverse complications, as it is observed in the treatment of long QT syndrome and catecholaminergic ventricular tachycardia 6,7 . Nevertheless, it is important to emphasize that similar results have been obtained with clipping or cauterization of the sympathetic chain in the treatment of primary hyperhidrosis 22 .…”

Effects of stepwise denervation of the stellate ganglion: Novel insights from an acute canine study

“…In left-sided CSD procedures, the lower half (T1-T4) of the left side of the SG (LSG) is removed. 5 A recent work by Buckley and Ardell showed that T1-T2 surgical excision is sufficient to functionally interrupt central control of peripheral sympathetic efferent activity. 6 However, the upper part of T1 of the LSG and ansae subclaviae remain connected to the heart and can still affect cardiac function through these remaining sympathetic innervations.…”

The role of sympathectomy in long QT syndrome

“…They proposed that LCSD should be considered for patients with recurrent syncope episodes under maximal pharmacological treatment and for patients who suffer arrhythmia storms in the presence of an ICD. More studies have emerged following that paper, but in the majority of them some 20 to 50% of the patients do remain symptomatic having had LCSD (15)(16)(17)(18)(19)(20)(21)(22) and there are also studies that identified that almost 50% of high-risk patients may experience more than one cardiac event post LCSD (14,20). Atallah et al (17) described that four patients with LQTS underwent VATS LCSD.…”

“…This technique provides a good denervation result without the high occurrence of Horner's, as most of the sympathetic fibres directed to the ocular region usually cross the upper portion of the left stellate ganglion and thus are spared (14). The original approach of open thoracotomy (anterior transthoracic or transaxillary) that was utilised at the start and middle of the twentieth century is now replaced by the minimally invasive approach of video-assisted thoracoscopic LCSD (VATS-LCSD) (15,(17)(18)(19)21,22). Some centres opt out for a supraclavicular retropleural approach, making thoracic drainage unnecessary (23).…”