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

## TL;DR

A 49-year-old woman with drug-resistant long QT syndrome underwent a successful left cardiac sympathetic denervation surgery with safe perioperative management.

## Contribution

Demonstrates safe perioperative strategies for LCSD in drug-refractory long QT syndrome.

## Key findings

- Thoracoscopic LCSD was performed without arrhythmia or hemodynamic instability.
- The patient remained stable postoperatively with no further ICD activations.
- Total intravenous anesthesia and paravertebral block minimized sympathetic activation.

## Abstract

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.

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.

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