[SCD-FORUM] READING THE LECTURE BY DR. LEXIN WANG.THREE EXPERT QUESTIONS BY DR. MERINO

[SCD Symposium]

Left cardiac sympathectomy to manage beta-blocker resistant LQT patients
Lexin Wang

Dr. José Luis Merino (Spain)
- LCSD should be considered in all types of long QT syndrome (LQTS)  
or there are specific types (i.e. LQTS 3) which are specially  
adequate or inadequate for it?

Dr. Lexin Wang (Australia)
There is limited knowledge about the therapeutic effects LCSD and  
genotypes of LQTS. In most reported cases including my own, LCSD was  
performed in patients who failed to respond to full dose beta- 
blockers, regardless of the types of LQTS. One interesting  
observation, however, is that LCSD has no significant effect on  
resting heart rate. This is probably an advantage for treating LQT3  
patients who often have a disproportionally prolonged QT interval  
(and risk of SCD) at a lower heart rate during beta-blocker therapy.


Dr. José Luis Merino (Spain)
- LCSD should be limited to a few centers with high experience in the  
treatment of this patients or is a technique which can be easily  
implemented and performed in regular centers?

Dr. Lexin Wang (Australia)
- The surgical techniques for LCSD have evolved significantly over  
the recent years. The development of video-assisted endoscopic LCSD  
(Li J, et al. PACE 2003; 26:870-873) means that the procedure can be  
performed by thoracic surgeons who are familiar with the anatomy of  
left cardiac sympathetic ganglion in a very short period of time  
(20-30 min in our experiences) with little complication or blood  
loss. Patients can be discharged 2-3 days after the surgery. It does,  
however, require close collaboration between cardiologists and  
surgeons in terms of pre- and post-surgical care and follow-ups.


Dr. José Luis Merino (Spain)
- Do you consider LCSD without ICD implantation in any patient?

Dr. Lexin Wang (Australia)
- This is an excellent but rather complex question. In my cohort of  
patients who underwent LCSD, ICD was not an option becasue of  
financial constraints. None of them received an ICD after the LCSD  
but they were doing very well 3-4 years after the surgery.

On the other hand, patients who have already received an ICD, LCSD  
would substantially reduce the number of shocks, improving the  
longevity of the ICD and patients' quality of life. As to do we need  
to consider ICD after LCSD, I would suggest that we have a debate on  
this throughout the course of the symposium.  My answer to this  
question is that it will depend on the risk of SCD, access to the ICD  
devices and quality of life considerations.


--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee




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