Left Cardiac Sympathetic Denervation via Thoracoscope to Treat Long QT Syndrome

Dayi Hu1, Cuilan Li1, Jun Wang2, Lexin Wang3, Chien-Chih Lin4, Wenling Liu1, Jianfeng Li2, Zhiming Li1, Lei Li1
From 1Department of Cardiology, 2Department of Thoracic Surgery, the People's Hospital of Peking University, Beijing 100044, China; 3School of Biomedical Sciences, Charles Sturt University, Australia; 4The Surgical Department of Tainan Municipal Hospital, Tainan, Taiwan

HU ET AL.: Left Cardiac Sympathetic Denervation via Thoracoscope to Treat Long QT Syndrome. Purpose: Long QT syndrome (LQTS) is a cardiovascular disorder characterized by prolongation of the QT interval on ECG and presence of syncope, seizures, and sudden cardiac death. The therapy for LQTS is mainly dependent on medicines. The aim of the present study was to investigate the feasibility and efficacy of a new surgical method of cardiac sympathectomy for LQTS patients. Methods: Left cardiac sympathetic denervation (LCSD) were conducted on 4 LQTS patients who were resistant to b-blockers. Patients' ECG and clinical symptoms were assessed before and after the surgery. Results: LCSD was successful in all patients. QTc decreased from 0.54±0.08 to 0.51±0.06s immediately after the procedure. However the shortened QTc returned to prior surgery level in one patient within 24 hours of the surgery. Before LCSD, horizontal bike exercise induced a significant change in T wave amplitude and prolongation in QTc. These changes diminished following LCSD. After 5-month follow-up, one patient who had frequent syncopal attacks before LCSD experienced 2 episodes of transient syncope. No syncope was reported by other patients. Conclusions: LCSD is a safe and effective therapy for LQTS resistant to b-blockers. These results may have significant implications in patients of developing countries like China, where expensive therapies such as implantable cardioverter defibrillator are unlikely to be widely applied due to financial constraints of the patients. (J HK Coll Cardiol 2002;10:184-190)

Key words : Corrected QT interval, Holter monitoring ECG, horizontal bike exercise test, left cardiac sympathetic denervation, long QT syndrome(LQTS)

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