Effect of Left Cardiac Sympathetic Denervation on the Electromechanical Window in Patients with either Type 1 or Type 2 Long QT Syndrome: A Pilot Study

Andrew E. Schneider, J. Martijn Bos, Michael John Ackerman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Left cardiac sympathetic denervation (LCSD) exerts significant antifibrillatory effects in patients with long QT syndrome (LQTS). Recently, electromechanical window (EMW) has emerged as a novel torsadogenic marker in LQTS, superior to QT interval (QTc) in distinguishing symptomatic from asymptomatic patients. Objective: To explore the hypothesis that LCSD improves EMW most favorably in patients with LQT1. Design: From September 2006 to July 2015, 44 LQT1 and 25 LQT2 patients underwent LCSD. Subset analysis was performed on the six LQT1 and seven LQT2 patients who had echocardiograms both pre-LCSD and ≥3 months post-LCSD. EMW is defined as the time difference (ms) between aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. Results: Compared to published normal EMW values of 22 ± 19 ms, pre-LCSD EMW mean values were −78 ± 36 ms in LQT1 and −71 ± 35 ms in LQT2 (P <.001). Following LCSD, there was a 57 ± 35 ms decrease in QTc in LQT1 (P =.16) and 23 ± 21 ms decrease in QTc in LQT2 (P =.3). Overall, there was a 35 ± 57 ms mean improvement in EMW post-LCSD (P =.04). Five of the 6 (83%) LQT1 subjects had a favorable EMW change post-LCSD (mean improvement 56 ± 25 ms, P =.04). Five of the 7 (71%) LQT2 subjects had a favorable EMW change post-LCSD (mean improvement 18 ± 19 ms, P =.2). Conclusions: The precise mechanism of the LCSD therapeutic effect in LQTS patients is not fully understood. This pilot study raises the possibility that LCSD's antitorsadogenic effect in patients with LQT1 could be conferred in part by restoration of electromechanical order, evidenced by normalization of the EMW.

Original languageEnglish (US)
Pages (from-to)437-443
Number of pages7
JournalCongenital Heart Disease
Volume11
Issue number5
DOIs
StatePublished - Sep 1 2016

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Long QT Syndrome
Sympathectomy
Therapeutic Uses
Aortic Valve
Electrocardiography

Keywords

  • Electromechanical Window
  • Genetics
  • Left Cardiac Sympathetic Denervation
  • Long QT Syndrome
  • Pediatric
  • Sudden Cardiac Death

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Effect of Left Cardiac Sympathetic Denervation on the Electromechanical Window in Patients with either Type 1 or Type 2 Long QT Syndrome : A Pilot Study. / Schneider, Andrew E.; Bos, J. Martijn; Ackerman, Michael John.

In: Congenital Heart Disease, Vol. 11, No. 5, 01.09.2016, p. 437-443.

Research output: Contribution to journalArticle

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abstract = "Background: Left cardiac sympathetic denervation (LCSD) exerts significant antifibrillatory effects in patients with long QT syndrome (LQTS). Recently, electromechanical window (EMW) has emerged as a novel torsadogenic marker in LQTS, superior to QT interval (QTc) in distinguishing symptomatic from asymptomatic patients. Objective: To explore the hypothesis that LCSD improves EMW most favorably in patients with LQT1. Design: From September 2006 to July 2015, 44 LQT1 and 25 LQT2 patients underwent LCSD. Subset analysis was performed on the six LQT1 and seven LQT2 patients who had echocardiograms both pre-LCSD and ≥3 months post-LCSD. EMW is defined as the time difference (ms) between aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. Results: Compared to published normal EMW values of 22 ± 19 ms, pre-LCSD EMW mean values were −78 ± 36 ms in LQT1 and −71 ± 35 ms in LQT2 (P <.001). Following LCSD, there was a 57 ± 35 ms decrease in QTc in LQT1 (P =.16) and 23 ± 21 ms decrease in QTc in LQT2 (P =.3). Overall, there was a 35 ± 57 ms mean improvement in EMW post-LCSD (P =.04). Five of the 6 (83{\%}) LQT1 subjects had a favorable EMW change post-LCSD (mean improvement 56 ± 25 ms, P =.04). Five of the 7 (71{\%}) LQT2 subjects had a favorable EMW change post-LCSD (mean improvement 18 ± 19 ms, P =.2). Conclusions: The precise mechanism of the LCSD therapeutic effect in LQTS patients is not fully understood. This pilot study raises the possibility that LCSD's antitorsadogenic effect in patients with LQT1 could be conferred in part by restoration of electromechanical order, evidenced by normalization of the EMW.",
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N2 - Background: Left cardiac sympathetic denervation (LCSD) exerts significant antifibrillatory effects in patients with long QT syndrome (LQTS). Recently, electromechanical window (EMW) has emerged as a novel torsadogenic marker in LQTS, superior to QT interval (QTc) in distinguishing symptomatic from asymptomatic patients. Objective: To explore the hypothesis that LCSD improves EMW most favorably in patients with LQT1. Design: From September 2006 to July 2015, 44 LQT1 and 25 LQT2 patients underwent LCSD. Subset analysis was performed on the six LQT1 and seven LQT2 patients who had echocardiograms both pre-LCSD and ≥3 months post-LCSD. EMW is defined as the time difference (ms) between aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. Results: Compared to published normal EMW values of 22 ± 19 ms, pre-LCSD EMW mean values were −78 ± 36 ms in LQT1 and −71 ± 35 ms in LQT2 (P <.001). Following LCSD, there was a 57 ± 35 ms decrease in QTc in LQT1 (P =.16) and 23 ± 21 ms decrease in QTc in LQT2 (P =.3). Overall, there was a 35 ± 57 ms mean improvement in EMW post-LCSD (P =.04). Five of the 6 (83%) LQT1 subjects had a favorable EMW change post-LCSD (mean improvement 56 ± 25 ms, P =.04). Five of the 7 (71%) LQT2 subjects had a favorable EMW change post-LCSD (mean improvement 18 ± 19 ms, P =.2). Conclusions: The precise mechanism of the LCSD therapeutic effect in LQTS patients is not fully understood. This pilot study raises the possibility that LCSD's antitorsadogenic effect in patients with LQT1 could be conferred in part by restoration of electromechanical order, evidenced by normalization of the EMW.

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