JTCS Tips for Better Browsing
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Cruz, J.
Right arrow Articles by Silva-Carvalho, L.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Cruz, J.
Right arrow Articles by Silva-Carvalho, L.
Related Collections
Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2009;137:664-669
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity

Jorge Cruz, MD, PhDa,c,*, João Sousa, MDb,c, Antonio G. Oliveira, MD, PhDd, Luis Silva-Carvalho, MD, PhDe,f

a Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal
b Service of Cardiology, Hospital de Santa Maria, Lisbon, Portugal
c Instituto Cardiovascular de Lisboa, Lisbon, Portugal
d Department of Biostatistics, Faculty of Medical Sciences, Universidade Nova de Lisboa, Lisbon, Portugal
e Instituto de Fisiologia, Faculdade de Medicina de Lisboa, Lisbon, Portugal
f Instituto de Medicina Molecular, Lisbon, Portugal

Received for publication February 19, 2008; revisions received June 7, 2008; accepted for publication July 6, 2008.

* Address for reprints: Jorge Cruz, MD, PhD, Avenida Guerra Junqueiro No. 11-4°, Esquerdo 1000-166 Lisboa, Portugal. (Email: costacruzjorge{at}gmail.com).

Objective: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system.

Methods: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later.

Results: We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity.

Conclusion: These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

Abbreviations and Acronyms ETS = endoscopic thoracic sympathectomy; HF = high-frequency; HFnu = high-frequency power in normalized units; HRV = heart rate variability; LF = low-frequency; LFnu = low-frequency power in normalized units; NN = normal R-R intervals; NO = nitric oxide; pNN50 = rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval; rMSSD = square root of the mean squared differences of successive normal R-R intervals; SDANN = SD of average normal R-R intervals; SDNN = SD of normal R-R intervals






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2009 by The American Association for Thoracic Surgery.