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High thoracic left sympathectomy for recalcitrant ventricular tachyarrhythmias and long QT syndrome

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

High thoracic left sympathectomy (HTLS) is a therapeutic option for patients with recalcitrant ventricular tachyarrhythmias and long QT syndrome not fully protected by antiarrhythmics. Here, we present our experience with HTLS.

Methods

This study included 12 patients with symptomatic ventricular tachyarrhythmias refractory to antiarrhythmics, who underwent high thoracic left sympathectomy (HTLS) in our institute from 2010 to 2012. Nine were females and three were males. The mean age at HTLS was 31.25 ± 3.12 years (range 7–48 years). All underwent complete clinical evaluation. Out of 12 cases, five were diagnosed clinically as long QT syndrome (LQTS), two were catecholaminergic polymorphic ventricular tachycardia (CPVT), two were polymorphic ventricular tachycardia (PVT), and three were ventricular tachycardia (VT) storm. One patient with long QT syndrome had an implantable cardioverter defibrillator (ICD) in situ, whose battery was discharging rapidly, and another patient with long QT syndrome had an associated ASD. Three had systemic hypertension with left ventricular dysfunction. The QT interval and the QTc were recorded in those patients with LQTS both preoperatively and postoperatively at 3 months and 12 months.

Indications for surgery were recurrent episodes of syncope, symptomatic ventricular tachyarrhythmias unresponsive to antiarrhythmics, and excessive implantable cardioverter defibrillator discharges.

All patients underwent HTLS via thoracoscopically assisted mini left midaxillary approach.

Results

There were no perioperative surgical complications. One patient died due to recurrence of ventricular tachycardia storm refractory to all abortive measures. The mean follow-up period was 4.8 ± 0.96 years. All others returned to normal sinus rhythm and maintained so with additional β-blockers.

Conclusion

HTLS is an effective therapeutic option and reduces arrhythmia burden in patients with recalcitrant ventricular tachyarrhythmias and long QT syndrome.

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Acknowledgement

We sincerely thank all patients who gave consent for the study.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Sri Jayadeva Institute of Cardiovasular Sciences and Research, Bengaluru, Karnataka, India

    Maruti Yamanappa Haranal, Prasanna Simha & Rakesh Rajasekharappa

  2. Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India

    Jayaprakash Shenthar

Authors
  1. Maruti Yamanappa Haranal
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  2. Prasanna Simha
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Correspondence to Maruti Yamanappa Haranal.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Haranal, M.Y., Simha, P., Shenthar, J. et al. High thoracic left sympathectomy for recalcitrant ventricular tachyarrhythmias and long QT syndrome. Indian J Thorac Cardiovasc Surg 34, 103–108 (2018). https://doi.org/10.1007/s12055-017-0548-4

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  • DOI: https://doi.org/10.1007/s12055-017-0548-4

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