Bilateral thoracoscopic sympathectomy for cardiac denervation in pediatric population: Does Kuntz nerve cauterization have an impact on success?
INTRODUCTION
Cardiac sympathetic denervation (CSD) is an effective procedure for the treatment of inherited channelopathies. Left CSD has traditionally been recommended as neuromodulation to prevent arrhythmia episodes; however, it is thought that bilateral sympathectomy in combination with Kuntz ablation may have additional effects effective due to the anatomical variability of preganglionic sympathetic fibers. The aim of the study was to share our single-center clinical experience with bilateral thoracoscopic sympathectomy for cardiac denervation in different groups of pediatric patients with malignant arrhythmias.


METHODS
Fourteen patients (seven with CPVT, five with LQTS, one with resistant ventricular tachycardia as a sequela of myocarditis, and one with cardiomyopathy and atrial tachycardia) underwent bilateral thoracoscopic sympathectomy for cardiac denervation.


RESULTS
In all patients, arrhythmia episodes persisted despite medical therapy, and patients with implantable cardioverter-defibrillator received appropriate therapies. The rate of appropriate therapies was 3.25 per year (1-5 per year) in the year before sympathectomy. No major complications related to the procedure were observed in any of the patients. The QTc interval of LQTS patients decreased from 506.2 ± 16.9 ms before the procedure to 476 ± 28.8 ms after the procedure. The mean duration of follow-up after the procedure was 23.3 months (11-47 months). Only two patients received single episodes of therapy 12 and 22 months after CSD, and one patient had arrhythmic events due to noncompliance to medical therapy.


CONCLUSION
Due to the anatomical variability of preganglionic fibers bilateral CSD with Kuntz nerve ablation effective treatment and is a safe option.
['Ertugrul|Ilker|I|https://orcid.org/0000-0002-6607-0568', 'Donmez|Yasemin N|YN|https://orcid.org/0000-0002-4689-5888', 'Aydın|Ahmet|A|https://orcid.org/0000-0003-1836-2061', 'Aykan|Hayrettin H|HH|https://orcid.org/0000-0001-5136-3977', 'Sel|Kutay|K|https://orcid.org/0000-0001-5932-7372', 'Uysal|Serkan|S|https://orcid.org/0000-0002-3969-2935', 'Yilmaz|Mustafa|M|https://orcid.org/0000-0003-3521-858X', 'Karagoz|Tevfik|T|https://orcid.org/0000-0002-7680-8183']
D002425:Cautery D002648:Child D006321:Heart D006801:Humans D008133:Long QT Syndrome D012189:Retrospective Studies D013562:Sympathectomy D017180:Tachycardia, Ventricular D016896:Treatment Outcome
bilateral sympathectomy catecholaminergic polymorphic ventricular tachycardia long QT syndrome sudden cardiac death video-assisted thoracoscopic surgery