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Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis

Abstract

Purpose

Primary palmar–plantar hyperhidrosis is the condition of excessive sweating of the hands and feet. For severe and medically refractory cases, endoscopic thoracic sympathotomy (ETS) is a bilateral ganglion-sparing disconnection between the stellate and T2 ganglion in an effort to minimize compensatory hyperhidrosis. The purpose of this study was to determine the effect of ETS on cardiac autonomic function.

Methods

Participants in this study were 22 otherwise healthy hyperhidrosis patients with 17 returning 1–12 months after surgery. Heart rate (HR) and blood pressure were collected at rest and during sequential nitroprusside/phenylephrine infusion (modified Oxford). To determine change in cardiac autonomic function, heart rate variability indices of RMSSD, LF and HF (log, nu) power were calculated. Sequential baroreflex sensitivity was also calculated.

Results

After surgery, resting HR on standardized ECG tended to be lower and reached significance during the modified Oxford baseline (p < 0.001). HRV changed significantly between assessments with an increase in HF (nu) and decrease in LF (nu) and LF (log) spectral ranges (p < 0.05), while the increase in RMSSD was marginally significant (p < 0.06). Compared with matched controls, HRV indices were significantly different before surgery, but similar after surgery. No change was detected in resting sequential baroreflex sensitivity, baroslope obtained by modified Oxford or QTc interval.

Conclusions

We conclude that ETS changes cardiac autonomic modulation of HR to levels similar to controls. Despite the minimally destructive nature of ETS, effects on HRV are consistent with previously reported post-sympathectomy blunting of exaggerated sympathetic control associated with hyperhidrosis. No significant changes in the baroreflex indices suggest that ETS did not significantly affect blood pressure regulation.

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Acknowledgments

Support for this project was provided by grants 1 UL1 RR024150* (Dr. Eisenach) and 1 KL2 RR024151 (Dr. Schmidt) from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov. The authors thank Pamela A. Engrav and Nicolee C Fode Thomas, for their recruiting efforts, and all of the patients for their enthusiastic participation.

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Correspondence to John H. Eisenach.

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Schmidt, J.E., Wehrwein, E.A., Gronbach, L.A. et al. Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis. Clin Auton Res 21, 11–17 (2011). https://doi.org/10.1007/s10286-010-0080-8

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Keywords

  • Hyperhidrosis
  • Endoscopic thoracic sympathotomy
  • Cardiac autonomic function
  • Heart rate variability
  • Baroreflex sensitivity