Department of Cardiology, Sydney Children's Hospital, University of New South Wales, Sydney, NSW 2031, Australia.
Heart Lung Circ. 2011 Nov;20(11):731-3. doi: 10.1016/j.hlc.2011.03.003. Epub 2011 Apr 7.
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a life threatening arrhythmia induced by sympathetic stimulation in susceptible individuals is often refractory to antiarrhythmic agents. First line of treatment, beta-blockers can be ineffective in up to 50% with implantable cardioverter-defibrillator (ICD) placement for refractory cases. Paradoxically ICD can be arryhthmogenic from shock-associated sympathetic stimulation, initiating more shocks and "electrical storms". This has led to the use of more effective beta blockade offered by left sympathectomy, now performed by minimally invasive video assisted thoracoscopic surgery (VATS). Sympathectomy has been traditionally performed long after ICD placement, after the patient has experienced multiple shocks, thus necessitating two procedures. We report simultaneous ICD insertion and thoracoscopic sympathectomy in a 10 year-old boy with CPVT, and suggest it as a better approach than sequential procedures. To our knowledge this is first such reported case.
儿茶酚胺多形性室性心动过速（CPVT）是一种由易感个体的交感神经刺激引起的危及生命的心律失常，通常对抗心律失常药物有抗药性。一线治疗方法，β受体阻滞剂在多达 50%的患者中可能无效，对于难治性病例需要植入式心脏复律除颤器（ICD）。矛盾的是，ICD 可能会因电击相关的交感神经刺激而引起心律失常，从而引发更多的电击和“电风暴”。这导致了使用更有效的左侧交感神经切除术提供的β阻断治疗，现在通过微创电视辅助胸腔镜手术（VATS）进行。交感神经切除术传统上是在 ICD 放置后很长时间后进行的，此时患者已经经历了多次电击，因此需要进行两次手术。我们报告了一例 10 岁 CPVT 男孩同时进行 ICD 插入和胸腔镜交感神经切除术，并建议这种方法优于序贯手术。据我们所知，这是首例此类报道。
