Abstract
Postural orthostatic tachycardia syndrome is characterized by orthostatic intolerance. Orthostasis (or other mild physical stress) triggers a cascade of inappropriate tachycardia, lightheadedness, palpitations, and often fainting. The underlying defect is sympathetic dysregulation of the heart, which receives its sympathetic tone from the cervical and upper thoracic sympathetic ganglia. Primary hyperhidrosis is also thought to be the result of sympathetic dysregulation. We present the case of a patient treated with CT-guided, percutaneous T2 EtOH sympatholysis for craniofacial hyperhidrosis. The patient also suffered from postural orthostatic tachycardia syndrome for many years and was unresponsive to treatment. Immediately after sympatholysis, the patient experienced resolution of both craniofacial hyperhidrosis and postural orthostatic tachycardia syndrome.
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References
Deb A, Morgenshtern K, Culbertson CJ, Wang LB, Hohler AD. A survey-based analysis of symptoms in patients with postural orthostatic tachycardia syndrome. Proc (Bayl Univ Med Cent). 2015;28(2):157–69.
Abed H, Ball PA, Wang LX. Diagnosis and management of postural orthostatic tachycardia syndrome: a brief review. J Geriatr Cardiol. 2012;9:61–7.
Sheldon RS, Grubb BP, Olshansky B, Shen WK, Calkins H, Brignole M, Raj SR, Krahn AD, Morillo CA, Stewart JM, Sutton R, Sandroni P, Friday KJ, Hachul DT, Cohen MI, Lau DH, Mayuga KA, Moak JP, Sandhu RK, Kanjwal K. 2015 Heart rhythm society expert consensus statement on the diagnosis and treatment of postural orthostatic tachycardia syndrome, inappropriate sinus tachycardia and vasovagal syncope. Heart Rhythm. 2015;12(6):e41–63.
Goldstein DS, Holmes C, Frank SM, Dendi R, Cannon RO, Sharabi Y, Esler MD, Eisenhofer G. Cardiac sympathetic dysautonomia in chronic orthostatic intolerance syndromes. Circulation. 2002;106:2358–65.
Schwartz PJ. Cardiac sympathetic denervation to prevent life-threatening arrhythmias. Nat Rev/Cardiol. 2014;11:346–53.
Ong W, Lee A, Tan WB, Lomanto D. Long-term results of a randomized controlled trial of T2 versus T2-T3 ablation in endoscopic thoracic sympathectomy for palmar hyperhidrosis. Surg Endosc. 2016;30(3):1219–25.
Joo S, Lee GD, Haam S, Lee S. Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy vs R4 sympathetic clipping versus R3 sympathetic clipping. J Thorac Dis. 2016;8(5):934–41.
Romano M, Giojelli A, Mainenti PP, Tamburrini O, Salvatore M. Upper thoracic sympathetic chain neurolysis under CT guidance. A two-year follow-up in patients with palmar and axillary hyperhidrosis. Radiol Med. 2002;104(5–6):421–5.
Hofferberth SC, Cecchin F, Loberman D, Fynn-Thompson F. Left thoracoscopic sympathectomy for cardiac denervation in patients with life-threatening ventricular arrhythmias. J Thorac Cardiovasc Surg. 2014;147(1):404–9.
Vaseghi M, Gima J, Kanaan C, Ajijola OA, Marmureanu A, Mahajan A, Shivkumar K. Cardiac sympathetic denervation in patients with refractory ventricular arrhythmias or electrical storm: intermediate and long-term follow up. Heart Rhythm. 2014;11:360–6.
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Brock, M., Chung, T.H., Gaddam, S.R. et al. Resolution of Postural Orthostatic Tachycardia Syndrome After CT-Guided, Percutaneous T2 Ethanol Ablation for Hyperhidrosis. Cardiovasc Intervent Radiol 39, 1785–1788 (2016). https://doi.org/10.1007/s00270-016-1455-6
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DOI: https://doi.org/10.1007/s00270-016-1455-6