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

• Published in: Indian journal of thoracic and cardiovascular surgery 2018-04, Vol.34 (2), p.103-108
• Main Authors: Haranal, Maruti Yamanappa, Simha, Prasanna, Shenthar, Jayaprakash, Rajasekharappa, Rakesh
• Format: Article
• Language: English
• Subjects: Cardiac Surgery; Medicine; Medicine & Public Health; Original Article; Surgery; Thoracic Surgery; Vascular Surgery
• ISSN: 0970-9134; 0973-7723
• DOI: 10.1007/s12055-017-0548-4

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.