Perioperative management of thoracoscopic left cardiac sympathetic denervation for refractory long QT syndrome: a case report.

IF 1.2 Q3 ANESTHESIOLOGY

JA Clinical Reports Pub Date : 2025-10-22 DOI:10.1186/s40981-025-00815-7

Asako Nitta, Atsushi Sawada, Kanami Abe, Naoyuki Kamiyama, Yuki Takahashi, Masahiro Miyajima, Mitsutaka Edanaga, Michiaki Yamakage

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引用次数: 0

Abstract

Background: Long QT syndrome (LQTS) refractory to standard treatments, including β-blockers and implantable cardioverter-defibrillators (ICDs), has been indicated for left cardiac sympathetic denervation (LCSD) in Europe and the United States. However, the clinical implementation of LCSD remains rarely performed in Japan as it is not covered by national health insurance.

Case presentation: A 49-year-old woman with LQTS experienced frequent ICD activations, and β-blocker up-titration was limited due to severe heart failure. As a stellate ganglion block transiently shortened QT interval, LCSD was considered to prevent life-threatening arrhythmic events. Total intravenous anesthesia combined with a left thoracic paravertebral block was used to attenuate sympathetic nervous activation. Thoracoscopic LCSD was performed without arrhythmia or hemodynamic instability. The patient remained stable postoperatively, with no further ICD activations.

Conclusion: This case demonstrates the safe perioperative management of LCSD for drug-refractory LQTS by incorporating strategies to minimize QT prolongation and suppress malignant arrhythmias.

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胸腔镜下左心交感神经去支配治疗难治性长QT综合征的围手术期处理1例。

背景：长QT综合征（LQTS）难以接受标准治疗，包括β受体阻滞剂和植入式心律转复除颤器（ICDs），在欧洲和美国已被指用于左心交感神经去支配（LCSD）。然而，由于不包括在国民健康保险范围内，日本很少开展康文署的临床服务。病例介绍：一名患有LQTS的49岁女性经历了频繁的ICD激活，由于严重的心力衰竭，β受体阻滞剂的上升滴定受到限制。作为星状神经节阻滞短暂缩短QT间期，LCSD被认为可以预防危及生命的心律失常事件。采用全静脉麻醉联合左胸椎旁阻滞来减弱交感神经的激活。胸腔镜下LCSD无心律失常或血流动力学不稳定。患者术后保持稳定，没有进一步的ICD激活。结论：本病例通过结合减少QT间期延长和抑制恶性心律失常的策略，证明了LCSD对药物难治性LQTS的围手术期安全管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JA Clinical Reports ANESTHESIOLOGY-

CiteScore

1.30

自引率

0.00%

发文量

审稿时长

9 weeks

期刊介绍： JA Clinical Reports is a companion journal to the Journal of Anesthesia (JA), the official journal of the Japanese Society of Anesthesiologists (JSA). This journal is an open access, peer-reviewed, online journal related to clinical anesthesia practices such as anesthesia management, pain management and intensive care. Case reports are very important articles from the viewpoint of education and the cultivation of scientific thinking in the field of anesthesia. However, submissions of anesthesia research and clinical reports from Japan are notably decreasing in major anesthesia journals. Therefore, the JSA has decided to launch a new journal, JA Clinical Reports, to encourage JSA members, particularly junior Japanese anesthesiologists, to publish papers in English language.