Although high thoracic left Sympathectomy via art 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 Horner's syndrome may 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 Horner'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.
* ANDREW E. EPSTEIN11Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama,
* MICHAEL J. ROSNER,**Division of Neurosurgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama
* GILBERT R. HAGEMAN,****Department of Physiology and Biophysics, The University of Alabama at Birmingham, Birmingham, Alabama
* JAMES H. BAKER, II11Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama,
* VANCE J. PLUMB11Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, and
* G. NEAL KAY11Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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1Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama *Division of Neurosurgery, Department of Surgery, The University of Alabama at Birmingham, Birmingham, Alabama **Department of Physiology and Biophysics, The University of Alabama at Birmingham, Birmingham, Alabama