Endoscopic thoracic sympathectomy for long QT syndrome

A 54-year-old woman was referred to our service with intractable ventricular arrhythmias secondary to a familial long-QT syndrome. Her first presentation was 4 years previously, when she suffered a cardiac arrest, at this time an (Automatic Implantable Cardioverter Defibrillator) AICD device was inserted and she was commenced on sympathetic blockers. She remained symptomatic with ongoing tachyarrhythmias and the subsequent automatic cardioversion or defibrillation was causing significant amount of distress.

She underwent a left transthoracic endoscopic cardiac sympathectomy and made a good postoperative recovery. She remains asymptomatic at four months.

Though open sympathectomy is an established treatment, there are only isolated reports of thoracoscopic sympathetic cardiac denervation in the literature.