Video-thoracoscopic left cardiac sympathetic denervation for long-QT syndrome

Abstract

Background Congenital long-QT syndrome represents the most common cardiac channelopathy and manifests as potentially lethal ventricular arrhythmias. Prevention strategies include beta-blockade pharmacotherapy, implantable cardioverter-defibrillators, and left cardiac sympathetic denervation, which can increase the threshold for ventricular fibrillation. Herein, we report our experience with video-assisted thoracoscopic left cardiac sympathetic denervation. Methods We performed a retrospective review of the electronic medical records of all patients with congenital long-QT syndrome who underwent video-assisted thoracoscopic left cardiac sympathetic denervation at our institution. Results From September 2009 to May 2016, 6 patients with a mean age of 30.5 years (range 20–47 years) underwent video-assisted thoracoscopic left cardiac sympathetic denervation for medically refractory long-QT syndrome. All patients had an uneventful recovery and were discharged 1–3 days after the operation. At a median follow-up of 14 months (range 12–60 months), 4 patients had no cardiac events while 2 experienced 1 episode of arrhythmic syncope and 1 episode of appropriate implantable cardioverter-defibrillator shock. Following surgery, the mean annual cardiac events in the study cohort decreased from 2.13 to 0.33 ( p = 0.004) and the mean corrected QT interval reduced from 560 ms to 491 ms ( p = 0.006). Conclusions Video-assisted thoracoscopic left cardiac sympathetic denervation is a safe and effective therapy in patients with congenital long-QT syndrome who continue to suffer from recurrent life-threatening arrhythmias or frequent implantable cardioverter-defibrillator discharges despite maximum tolerated doses of beta blockers.

Clinical Advances in Congenital Long QT Syndrome

“…[42] Besides, video-assisted thoracoscopic left cardiac sympathetic denervation (VATS-LCSD) is a less invasive surgical procedure [Figure 2B], without serious complications, including Horner syndrome. [43] A previous study demonstrated that VATS-LCSD is a low-morbidity procedure that achieves a marked response in Chinese LQTS patients [Figure 2C and D]. [44] Gene-specific therapies LQT2 patients are extremely sensitive to serum potassium levels, which should be maintained at an appropriate level.…”

“…In a research of 147 LQTS patients, there was a >90% reduction in cardiac events post denervation [42] . Besides, video-assisted thoracoscopic left cardiac sympathetic denervation (VATS-LCSD) is a less invasive surgical procedure [Figure 2B], without serious complications, including Horner syndrome [43] . A previous study demonstrated that VATS-LCSD is a low-morbidity procedure that achieves a marked response in Chinese LQTS patients [Figure 2C and D] [44] …”

Síndrome de QT largo congénito

“…Esta técnica implica el aislamiento de los primeros tres o cuatro ganglios torácicos, preservando la porción cefálica del ganglio estrellado, para evitar el síndrome de Horner. Las limitaciones son logísticas, ya que su aplicabilidad depende de la experiencia del grupo quirúrgico, cuyo acceso puede ser por toracotomía o por toracoscopía 67 , 68 . En niños pequeños, el acceso es por el tercer espacio intercostal, donde hay una visualización adecuada del ganglio simpático y estrellado.…”