Left cardiac sympathetic denervation in children. A matter of facts

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.