Abstract 5692: Video-Assisted Thoracoscopic Cardiac Denervation: A Potential Novel Therapeutic Option for Children with Intractable Ventricular Arrhythmias
Background: Left cardiac sympathetic denervation is one of the therapeutic modalities used in the management of patients with medically refractory long QT syndrome. Traditionally, a thoracotomy and/or cervical incision have been utilized as the standard surgical approach. Video-assisted thoracoscopic surgery allows a minimally invasive technique. There is only one published series on the use of video-assisted thoracoscopic surgery for left cardiac sympathetic denervation in patients with long QT syndrome.
Methods: Between 2000 and 2008, a total of 9 patients underwent left cardiac sympathetic denervation at Children’s Hospital Boston, all being performed using a video-assisted thoracoscopic approach. Approval was obtained from the Committee for Clinical Investigation and a retrospective chart review was performed.
Results: Four patients were diagnosed with congenital long QT syndrome (2 with Jervell and Lange-Nielson syndrome), 4 with catecholaminergic polymorphic ventricular tachycardia and one with idiopathic recalcitrant ventricular tachycardia. The age at sympathectomy ranged between 2 and 21 years. Follow-up ranged between 1 and 60 months. All patient were considered optimized on antiarrhythmic therapy. Frequent ICD shocks were the indication for sympathectomy in 5/9 patients. The remaining four patients had an ICD implanted at the time of sympathectomy. There were no severe post-operative complications. Only two patients had minor post-operative complications consisting of transient left arm pain in one and a transient Harlequin face in another. Of the symptomatic patients with available follow-up, 6/7 experienced marked improvement in the first month post sympathectomy, and 5 had complete resolution of arrhythmias.
Conclusion: This minimally invasive procedure provides a safe novel therapeutic option for children with drug-refractory catecholaminergic polymorphic ventricular tachycardia and other catecholamine-triggered arrhythmias.