Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery

Christopher A. Collura, Jonathan N. Johnson, Christopher Moir, Michael John Ackerman

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

Background: Long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) are two of the most common, potentially lethal, cardiac channelopathies. Treatment strategies for the primary and secondary prevention of life-threatening polymorphic ventricular tachycardia/fibrillation include pharmacotherapy with β-blockers, implantable cardioverter defibrillators, and left cardiac sympathetic denervation (LCSD). Objectives: This study sought to report our institutional experience with LCSD using video-assisted thoracic surgery (VATS). Methods: From November 2005 through November 2008, 20 patients (8 female, average age at surgery 9.1 ± 9.7 years, range 2 months to 42 years) underwent LCSD via either a traditional approach (N = 2) or VATS (N = 18). A total of 12 patients had genotype-positive LQTS (7 LQT1, 2 LQT2, 1 LQT3, 2 LQT1/LQT2), 2 had JLNS, 4 had genotype-negative LQTS, and 2 had CPVT1. Electronic medical records were reviewed for patient selection, perioperative complications, and short-term outcomes. Results: LCSD was performed as a secondary prevention strategy in 11 patients (8 LQTS patients, average QTc 549 ms) and as primary prevention in 9 patients (average QTc 480 ms). There were no perioperative complications, including no intraoperative ectopy, no uncontrolled hemorrhage, and no VATS cases requiring conversion to a traditional approach. The average length of available follow-up was 16.6 ± 9.5 months (range 4 to 40 months). Among the 18 patients who underwent VATS-LCSD, the average time from operation to dismissal was 2.6 days (range 1 day to 15 days), the majority being next-day dismissals. Among those receiving LCSD as secondary prevention, there has been a marked reduction in cardiac events. Conclusions: We present a series of 20 patients with LQTS and CPVT who underwent LCSD, 18 using VATS. The minimally invasive VATS surgical approach was associated with minimal perioperative complications, including no intraoperative ectopy and excellent immediate and short-term outcomes. Videoscopic denervation surgery, in addition to traditional LCSD, offers a safe and effective treatment option for the personalized medicine required for patients with LQTS/CPVT.

Original languageEnglish (US)
Pages (from-to)752-759
Number of pages8
JournalHeart Rhythm
Volume6
Issue number6
DOIs
StatePublished - Jun 2009

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Video-Assisted Thoracic Surgery
Long QT Syndrome
Sympathectomy
Secondary Prevention
Primary Prevention
Therapeutics
Andersen Syndrome
Genotype
Channelopathies
Precision Medicine
Polymorphic catecholergic ventricular tachycardia
Implantable Defibrillators
Electronic Health Records
Ventricular Fibrillation
Denervation
Ventricular Tachycardia
Patient Selection
Hemorrhage
Drug Therapy

Keywords

  • CPVT
  • denervation
  • Left cardiac sympathetic denervation
  • long QT syndrome
  • LQTS
  • VATS

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery. / Collura, Christopher A.; Johnson, Jonathan N.; Moir, Christopher; Ackerman, Michael John.

In: Heart Rhythm, Vol. 6, No. 6, 06.2009, p. 752-759.

Research output: Contribution to journalArticle

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T1 - Left cardiac sympathetic denervation for the treatment of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia using video-assisted thoracic surgery

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AU - Ackerman, Michael John

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N2 - Background: Long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) are two of the most common, potentially lethal, cardiac channelopathies. Treatment strategies for the primary and secondary prevention of life-threatening polymorphic ventricular tachycardia/fibrillation include pharmacotherapy with β-blockers, implantable cardioverter defibrillators, and left cardiac sympathetic denervation (LCSD). Objectives: This study sought to report our institutional experience with LCSD using video-assisted thoracic surgery (VATS). Methods: From November 2005 through November 2008, 20 patients (8 female, average age at surgery 9.1 ± 9.7 years, range 2 months to 42 years) underwent LCSD via either a traditional approach (N = 2) or VATS (N = 18). A total of 12 patients had genotype-positive LQTS (7 LQT1, 2 LQT2, 1 LQT3, 2 LQT1/LQT2), 2 had JLNS, 4 had genotype-negative LQTS, and 2 had CPVT1. Electronic medical records were reviewed for patient selection, perioperative complications, and short-term outcomes. Results: LCSD was performed as a secondary prevention strategy in 11 patients (8 LQTS patients, average QTc 549 ms) and as primary prevention in 9 patients (average QTc 480 ms). There were no perioperative complications, including no intraoperative ectopy, no uncontrolled hemorrhage, and no VATS cases requiring conversion to a traditional approach. The average length of available follow-up was 16.6 ± 9.5 months (range 4 to 40 months). Among the 18 patients who underwent VATS-LCSD, the average time from operation to dismissal was 2.6 days (range 1 day to 15 days), the majority being next-day dismissals. Among those receiving LCSD as secondary prevention, there has been a marked reduction in cardiac events. Conclusions: We present a series of 20 patients with LQTS and CPVT who underwent LCSD, 18 using VATS. The minimally invasive VATS surgical approach was associated with minimal perioperative complications, including no intraoperative ectopy and excellent immediate and short-term outcomes. Videoscopic denervation surgery, in addition to traditional LCSD, offers a safe and effective treatment option for the personalized medicine required for patients with LQTS/CPVT.

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