Posterior left thoracic cardiac sympathectomy by surgical division of the sympathetic chain: An alternative approach to treatment of the long QT syndrome

Academic Article


  • Although high thoracic left sympathectomy via an anterior surgical approach is a highly efficacious treatment for refractory ventricular arrhythmias in patients with the long QT syndrome, the degree of sympathetic denervation has been variable, success of the operation is influenced by anatomical differences between patients, and Homer's syndrome amy 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 sympathetic 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 risk of Homer's syndrome by avoiding the ocular sympathetic efferent nerves. This posterior approach is described in five patients with the long QT syndrome and recurrent ventricular arrhythmias. After a mean follow-up of 18 ± 12 months, all are alive without Homer's syndrome.
  • Authors

    Published In

    Digital Object Identifier (doi)

    Author List

  • Epstein AE; Rosner MJ; Hageman GR; Baker JH; Plumb VJ; Kay GN
  • Start Page

  • 1095
  • End Page

  • 1104
  • Volume

  • 19
  • Issue

  • 7