<HTML><BODY style="word-wrap: break-word; -khtml-nbsp-mode: space; -khtml-line-break: after-white-space; "><DIV><FONT class="Apple-style-span" face="Arial">Left cardiac sympathectomy to manage beta-blocker resistant LQT patients</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Lexin Wang</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. José Luis Merino (Spain)</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">- 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?</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Lexin Wang (Australia)</FONT></DIV><DIV><DIV><DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. José Luis Merino (Spain)</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- 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?</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. Lexin Wang (Australia)</FONT></DIV><DIV><DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- 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.</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV></DIV></DIV></DIV></DIV><FONT class="Apple-style-span" face="Arial">Dr. José Luis Merino (Spain)</FONT></DIV><DIV><DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- Do you consider LCSD without ICD implantation in any patient?</FONT></DIV></DIV><DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">Dr. Lexin Wang (Australia)</FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">- 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. </FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial"> </FONT></DIV><DIV class="MsoNormal"><FONT class="Apple-style-span" face="Arial">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.</FONT></DIV></DIV></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT><DIV><DIV><FONT class="Apple-style-span" face="Arial">--</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Sergio Dubner</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">President of Scientific Committee</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">Dr. Edgardo Schapachnik</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial">President of Steering Committee</FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><DIV><FONT class="Apple-style-span" face="Arial"><BR class="khtml-block-placeholder"></FONT></DIV><FONT class="Apple-style-span" face="Arial"><BR class="Apple-interchange-newline"></FONT></DIV><FONT class="Apple-style-span" face="GB18030 Bitmap"><BR></FONT></BODY></HTML>