What does this research mean for the field?

Left cervicothoracic sympathectomy is inadequate for long-term symptom control in most patients with long QT syndrome who are refractory to beta-blockers, typically necessitating additional interventions such as pacing, further surgery, or defibrillator implantation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the long-term therapeutic efficacy of left cardiac sympathectomy in patients with long QT syndrome experiencing recurrent syncope or cardiac arrest despite beta-blocker therapy.

December 1, 1984CirculationOpen Access

Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome.

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Why the study?

Does left cardiac sympathectomy prevent recurrent symptoms in patients with long QT syndrome refractory to beta-blockers?

Key Points

To evaluate the long-term therapeutic efficacy of left cardiac sympathectomy in patients with long QT syndrome experiencing recurrent syncope or cardiac arrest despite beta-blocker therapy.
Evaluated 10 patients with long QT syndrome (4 familial, 6 idiopathic) who failed high-dose beta-blockers.
Patients underwent left stellate ganglionectomy (N=1) or left cervicothoracic sympathectomy (N=9) and were followed for a mean of 38.6 ± 19 months.
Mean QTc interval shortened significantly from 556 ± 43 msec to 508 ± 65 msec (p < 0.05), though QTc remained abnormal in 9 of 10 patients.
Recurrent symptoms developed in 8 of 10 patients during follow-up, comprising cardiac arrest in 3 patients (1 fatal, 2 nonfatal), syncope in 4, and presyncope in 6.
Symptom management ultimately required more extensive sympathectomy (N=3), chronic atrial pacing (N=3), or an implantable defibrillator (N=1), leaving only 1 patient asymptomatic without further therapy.

Structured PICO

Does left cardiac sympathectomy prevent recurrent symptoms in patients with long QT syndrome refractory to beta-blockers?

Population

10 patients with long QT syndrome and recurrent syncope and/or cardiac arrest caused by ventricular arrhythmias, who failed to respond to high-dose beta-blocker therapy. The syndrome was familial in 4 and idiopathic in 6.

Intervention

Left stellate (n=1) or left cervicothoracic sympathectomy (n=9)

Outcome

Recurrent symptoms (cardiac arrest, syncope, presyncope) and QTc interval changeshard clinical

Left cervicothoracic sympathectomy is inadequate for long-term control of symptoms in most patients with long QT syndrome refractory to beta-blockers, often requiring additional therapies.

Discussion

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Implication

Recurrent symptoms after sympathectomy warrant caution against relying on it alone in refractory long QT; leaves open need for adjunctive strategies in prospective studies.

Cite This Study

Bhandari et al. (1984) studied this question.

synapsesocial.com/papers/6a1772ffcf49e78c48b40fd9 https://doi.org/10.1161/01.cir.70.6.1018

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Implication

Recurrent symptoms after sympathectomy warrant caution against relying on it alone in refractory long QT; leaves open need for adjunctive strategies in prospective studies.

Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome.

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome.

Key Points

Structured PICO

Discussion

Implication

Cite This Study

Also Consider

Also Consider