Cardiac Sympathectomy: Update Course 2017

Cardiac sympathectomy was first introduced in the 1940s as a treatment for angina, allowing patients to continue having MIs without pain

When cardiac surgery came in the 1950s, there was no need anymore for cardiac sympathectomy

In the 1970s there was a mild resurgence when Long QT syndrome was defined, but ICDs became the primary treatment

In the last 10 years, newer techniques of cardiac sympathectomy have come back because some Long QT patients continue to have life-threatening events despite appropriate medical treatment and ICDs

Catecholaminergic polymorphic VT is quite rare, with kids usually presenting in the 5-10 year age range with syncope or seizure during exercise or emotional states

CPVT has 50% mortality by 40 years of age, always related to sudden death

Primary treatment for CPVT is beta blockers, secondarily flecainide, and in addition ICDs

With combination therapy of beta blockers, flecainide, and ICD, most CPVT patients can live a normal lifespan

In catecholamine-driven disease, if patients get an inappropriate ICD shock when perfectly healthy, it is hard to suppress the adrenaline surge, creating risk of sudden death

Sympathectomy provides 100% compliance once performed, unlike daily medications

Sympathectomy can potentially attenuate the effects of adrenaline if there is an inappropriate shock or any other adrenaline surge

The ganglion must be anesthetized before doing anything to it because you can create a ventricular storm if you just clamp it without numbing it first

The first CPVT patient is 2.5 years post-sympathectomy with no ICD shocks since surgery

Hypertrophic cardiomyopathy is the number one cause of sudden death in young athletes, accounting for 50% of sudden deaths in the United States

Current 2015 guidelines say if you've had an arrest and have an ICD you should not play competitive sports, but they added 'but if you do' which changed practice

Guidelines require no events for six months, a functional device, and medication compliance before allowing return to sports

The HCM patient is 10 months post-sympathectomy and has not had an episode of VT or required a shock

Only the left side needs to be operated on because the sympathetic chain comes from the left side to the heart

Anyone giving anesthetics to ICD patients needs to be capable of full resuscitation, and if not, should rethink the location of the procedure

Almost everybody who has an ICD gets even minor procedures done in the hospital because if it requires inhaled or IV anesthetic, their risks are greater