Intraoperative Vagal Nerve Stimulation in a Patient with Long QT Syndrome during Thyroidectomy

Intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve is a useful tool during thyroidectomies for the safe accomplishment of the operation. The latest guidelines suggest that stimulation of vagus nerve is prerequisite for proper use of IONM. In the current bibliography there are not any data for the safety of vagal nerve stimulation in patients with certain diseases, such as long QT syndrome (LQTS). Here we present a case of a 51-year-old female patient with a known history of LQTS, who successfully underwent thyroidectomy and parathyroidectomy in our department with vagal nerve stimulation during IONM. Many concerns were raised preoperatively about the safety of vagus stimulation since it enervates myocardium and controls heart rate through the parasympathetic system. For this reason, the operation took place with a specialist cardiologist stand by ready to intervene, and a defibrillator ready for use. However, there were not any complications intraoperatively or postoperatively.