POSTERIOR LEFT THORACIC CARDIAC SYMPATHECTOMY BY SURGICAL DIVISION OFTHE SYMPATHETIC CHAIN - AN ALTERNATIVE APPROACH TO TREATMENT OF THE LONG QT SYNDROME

Although high thoracic left sympathectomy via an anterior surgical app roach is a highly efficacious treatment for refractory ventricular arr hythmias in patients with the long QT syndrome, the degree of sympathe tic denervation has been variable, success of the operation is influen ced by anatomical differences between patients, and Horner's syndrome may result. We hypothesized that interruption of sympathetic input to the heart could be accomplished using a posterior thoracic approach to this variable and often complex anatomy by division of the sympatheti c chain rather than by direct destruction of the stellate and superior thoracic ganglia with the more conventional anterior, supraclavicular approach. in addition, the posterior approach should decrease the ris k of Horner's syndrome by avoiding the ocular sympathetic efferent ner ves.' This posterior approach is described in five patients with the l ong QT syndrome and recurrent ventricular arrhythmias. After a mean fo llow-up of 18 +/- 12 months, all are alive without Horner's syndrome.