Abstract
Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac sympathectomy (CS) is a second-line treatment for drug-refractory adrenalin-sensitive channelopathies. We present our series of paediatric sympathectomies for long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT) as adjunctive treatment. Methods Between 2011 and 2021, 30 CS (28 left, 2 right) were performed by videothoracoscopy in 28 patients (21 LQTS and 7 CPVT), aged 8 days to 21 years. The mean follow-up was 29 months. All patients were treated pharmacologically before surgery, three had an implantable cardiac defibrillator (ICD). Indications for CS in patients with CPVT included previous cardiac arrest (3/7) and sustained VT induced by emotion/stress despite medication (4/7). In LQTS, indications included syncope (4/21), VT despite medication (7/21) and high risk of malignant arrhythmias (10/21). Results There were no intraoperative complications or deaths. Four patients had transient palpebral ptosis with mild miosis, 23/28 patients were monitored by ICD or subcutaneous holter. After sympathectomy, 24/28 remain asymptomatic; three patients experienced syncope and one received appropriate discharge. Seven patients experienced VT (3/7 due to pharmacological non-compliance) of which three required ICD and four improved with medication. During follow-up, five high-risk patients received ICDs for primary prevention. Conclusion CS is an effective and safe technique in children as an adjunctive treatment for severe arrhythmias due to channelopathies. After CS, 85% remained asymptomatic. Medication non-compliance is an important cause of VT after CS, although ICD was occasionally required. In our experience, long-term remote monitoring is key to effective follow-up.
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