Torsades de pointes ventricular tachycardia following right pneumonectomy: insights into the relation between right cardiac sympathetic nerve damage, QT intervals, and arrhythmias.
Polymorphic ventricular tachycardia in association with prolongation of the QT interval on the surface electrocardiogram (ECG) has long been recognized as an important cause of life threatening arrhythmias that can occur with congenital or acquired abnormalities of cardiac repolarization. One hypothesis of the origin of these arrhythmias states that overactivity of the left-sided sympathetic or under activity of the right-sided sympathetic neural input to the heart leads to prolonged repolarization and ventricular arrhythmias. This hypothesis has led to the application of left cervicothoracic sympathetectomy for control of arrhythmias in congenital long QT syndromes. Although animal models have shown QT prolongation following right stellate ganglionic section or left stellate stimulation, spontaneous ventricular arrhythmias following stellate stimulation or block in man have not been demonstrated. We report the case of a patient with life threatening ventricular arrhythmias following surgical damage to the right cardiothoracic sympathetic nerves.
Dorian
P
P
Department of Medicine, St. Michael's Hospital, Ontario, Canada.
Newman
D
D
Hughes
W
W
Langer
A
A
Freeman
M
M
D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging / Q000294:innervation*; D006801:Humans; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis; D011877:Radionuclide Imaging; D013564:Sympathetic Nervous System / Q000293:injuries*; D017256:Technetium Tc 99m Sestamibi; D013997:Time Factors; D016171:Torsades de Pointes / Q000175:diagnosis / Q000209:etiology*
D017256:Technetium Tc 99m Sestamibi