Long QT Syndrome is an uncommon disorder that is genetically transmitted and in which the first presenting sign is often syncope or sudden death.  Malignant Ventricular Arrythmia’s, most commonly Torsades de Pointes, a polymorphic Ventricular Tachycardia, are often triggered by physical or emotional stimuli.  Diagnosis is by EKG, with QTC greater than 440 msec in men and 460 msec in women, and abnormal T-wave morphology, including broad-based T-waves, notched T-waves, and T-wave alternans, in addition to ruling out acquired causes of a prolonged QT, including, medications.  Treatment is typically with Beta-Blockers, specifically Propranolol and Nadolol.  Avoid metoprolol and other Beta-Blockers as they are felt to have inadequate protection.  Mexiletine is often added as it blocks sodium channels that have been implicated in certain variants of Long QT Syndrome.  Patients should be considered for thoracoscopy guided Left Cardiac Sympathetic Denervation, with removal of the lower half of the stellate ganglion and of the first four thoracic ganglia.  This results in a shortening of the QT interval and a reduction of Torsades de Pointes, Ventricular Tachycardia, and Ventricular Fibrillation to a remarkable extent.  There is increasing evidence that, when Beta-Blockade, Mexiletine, and Left Cardiac Sympathetic Denervation is performed, an implantable cardiac defibrillator may not be necessary, except when the above triad fails or is unable to be utilized.