The Effects of Thoracic Sympathotomy on Heart Rate Variability in Patients with Palmar Hyperhidrosis

Abstract

PurposeTo observe the evolution of heart rate variability (HRV) in patients with palmar hyperhidrosis before and after endoscopic thoracic sympathotomy and to evaluate the effects of the surgery on the autonomic nervous system.Materials and MethodsEndoscopic thoracic sympathotomy was performed on 20 patients with palmar hyperhidrosis. The thoracic sympathetic chain at the level of the third to fourth rib (R3-R4) was transected, but the ganglia were left in position without removal. A slightly larger ramus, in comparison to the other rami, that arose laterally from the sympathetic chain was interrupted to achieve adequate sympathetic denervation of the upper extremity. Before and on the day after the surgery, 24-hour Holter Electrocardiograph was performed, obtaining time domain and frequency domain parameters.ResultsCompared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R-R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR interval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly. There was no statistical difference in high frequencies (HF, 0.15 to 0.40 Hz), LF/HF ratio (LF/HF), or standard deviation for all normal RR intervals for the entire 24-h recording (SDNN) before and after thoracic sympathotomy.ConclusionThere was a significant improvement in HRV in patients with palmar hyperhidrosis after thoracic sympathotomy. This may be attributable to an improvement autonomic nervous system balance and parasympathetic predominance in the early postoperative stage.

Hyperhidrosis, Endoscopic Thoracic Sympathectomy, and Cardiovascular Outcomes: A Cohort Study Based on the Korean Health Insurance Review and Assessment Service Database

“…However, growing evidence has shown that ETS as a treatment for hyperhidrosis has additional cardiovascular protective effects. Recent studies have reported a decrease in heart rate and sympathetic activity and an increase in vagal and cardiac autonomic activities among patients who underwent ETS [22,34]. Jeng et al reported increased carotid artery flow volume, increased middle cerebral artery flow velocity, and reduced blood pressure in hyperhidrosis patients after ETS [23].…”

Longitudinal follow-up of cardiac vagal activity in individuals undergoing endoscopic thoracic sympathectomy

“…The sympathetic fibers that innervate the heart, lungs, and other thoracic viscera can also be affected because they lie along the surgical path. Therefore, autonomic changes (particularly sympathetic nervous system changes) resulting from such surgical procedures are theoretically unavoidable 20 …”

Heart rate variability as a potential diagnostic tool to predict compensatory hyperhidrosis after sympathectomy in patients with primary focal hyperhidrosis

“…HRV is a simple and noninvasive electrocardiographic test showing activity and balance of the autonomous nervous system, which consists of sympathetic and parasympathetic components (17)(18)(19). Because the second and third sympathetic thoracic ganglia innervating the heart are ablated in sympathectomy, most previous studies have investigated changes in HRV findings after sympathectomy (20)(21)(22)(23)(24). However, few studies about associations between autonomic nervous activities, PFH characteristics, and postoperative outcomes have been performed.…”

“…However, few studies about associations between autonomic nervous activities, PFH characteristics, and postoperative outcomes have been performed. In particular, the association between autonomic nervous activities and CH remains unknown (12,14,22). The aims of this study are to investigate associations between autonomic nervous activity and PFH characteristics using HRV and to investigate the association between HRV findings and CH after sympathectomy.…”