JACC Case Rep. 2026 Oct 24:110888. doi: 10.1016/j.jaccas.2026.110888. Online ahead of print.
ABSTRACT
BACKGROUND: Congenital long QT syndrome (LQTS) with neonatal onset carries a high risk of drug-refractory ventricular arrhythmias. Continuous percutaneous left stellate ganglion block (PLSGB) as a bridge to left cardiac sympathetic denervation (LCSD) is unexplored in neonates.
CASE SUMMARY: We present a newborn female with in utero onset LQTS, complicated by functional 2:1 atrioventricular block and torsades de pointes (TdP). Despite pacemaker implantation, propranolol, and mexiletine, TdP recurred. At 25 days of life, continuous PLSGB with ropivacaine suppressed TdP. At 4 months, video-assisted thoracoscopic surgery (VATS)-LCSD was performed, with no ventricular arrhythmia recurrence in 24 months.
NOVELTY: First reported case of continuous PLSGB in a neonate with LQTS; among the few VATS-LCSD cases under 1 year.
TAKE-HOME MESSAGES: Early sympathetic neuromodulation should be considered in high-risk pediatric LQTS when medical therapy fails, as a bridge to LCSD. VATS-LCSD is feasible and safe even under 1 year.
PMID:42927478 | DOI:10.1016/j.jaccas.2026.110888