Left cardiac sympathetic denervation for the treatment of methadone-induced long QT syndrome

Abstract

Introduction Methadone remains one of the most common noncardiovascular drugs associated with the development of torsade de pointes (TdP), as QT interval prolongation can occur in up to 15% of methadone-maintenance patients. In fact, the overall use of methadone has increased significantly in the past decade, and it has also been found to be associated with an increased risk of sudden death in a community-based study. For patients with recurrent methadone-associated dP who are unable to discontinue the offending medicaion, an effective secondary prevention strategy is permaent pacing with defibrillator backup. However, there are ccasions when this treatment option is not clinically reaonable because of a high risk for cardiac device infection. e report one such case of an individual on methadone aintenance and a secondary-prevention implantable carioverter-defibrillator (ICD) who subsequently developed a evice infection. Given the patient’s clinical picture upon resentation, left cardiac sympathetic denervation (LCSD) as chosen as treatment. This case suggests that LCSD ight be an alternative to consider in patients on methadone ith significant QT interval prolongation, and thereby at isk for ventricular arrhythmias.