Skip to main content

Autonomic function following endoscopic thoracic sympathotomy for hyperhidrosis



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.


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.


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.


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.

This is a preview of subscription content, access via your institution.


  1. 1.

    Eisenach JH, Atkinson JL, Fealey RD (2005) Hyperhidrosis: evolving therapies for a well-established phenomenon. Mayo Clin Proc 80:657–666

    Article  PubMed  Google Scholar 

  2. 2.

    Atkinson JL, Fealey RD (2003) Sympathotomy instead of sympathectomy for palmar hyperhidrosis: minimizing postoperative compensatory hyperhidrosis. Mayo Clin Proc 78:167–172

    Article  PubMed  Google Scholar 

  3. 3.

    Shih CJ, Wu JJ, Lin MT (1983) Autonomic dysfunction in palmar hyperhidrosis. J Auton Nerv Syst 8:33–43

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Noppen M, Dendale P, Hagers Y, Herregodts P, Vincken W, D’Haens J (1996) Changes in cardiocirculatory autonomic function after thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis. J Auton Nerv Syst 60:115–120

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Papa MZ, Bass A, Schneiderman J, Drori Y, Tucker E, Adar R (1986) Cardiovascular changes after bilateral upper dorsal sympathectomy: Short- and long-term effects. Ann Surg 204:715–718

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Tedoriya T, Sakagami S, Ueyama T, Thompson L, Hetzer R (1999) Influences of bilateral endoscopic transthoracic sympathicotomy on cardiac autonomic nervous activity. Eur J Cardiothorac Surg 15:194–198

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Rudas L, Crossman AA, Morillo CA, Halliwill JR, Tahvanainen KU, Kuusela TA, Eckberg DL (1999) Human sympathetic and vagal baroreflex responses to sequential nitroprusside and phenylephrine. Am J Physiol 276:1691–1698

    Google Scholar 

  8. 8.

    Bertinieri G, Rienzo M, Cavallazzi A, Ferrari AU, Pedotti A, Mancia G (1985) A new approach to analysis of the arterial baroreflex. J Hypertens Suppl 3:S79–S81

    CAS  PubMed  Google Scholar 

  9. 9.

    Halliwill JR, Minson CT (2002) Effect of hypoxia on arterial baroreflex control of heart rate and muscle sympathetic nerve activity in humans. J Appl Physiol 93:857–864

    PubMed  Google Scholar 

  10. 10.

    Hesse C, Charkoudian N, Liu Z, Joyner MJ, Eisenach JH (2007) Baroreflex sensitivity inversely correlates with ambulatory blood pressure in healthy normotensive humans. Hypertension 50:41–46

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Kingma R, TenVoorde BJ, Scheffer GJ, Karemaker JM, Mackaay AJ, Wesseling KH, de Lange JJ (2002) Thoracic sympathectomy: effects on hemodynamics and baroreflex control. Clin Auton Res 12:35–42

    Article  PubMed  Google Scholar 

  12. 12.

    Cruz J, Sousa J, Oliveira AG, Silva-Carvalho L (2009) Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity. J Thorac Cardiovasc Surg 137:664–669

    Article  PubMed  Google Scholar 

  13. 13.

    Birner P, Heinzl H, Schindl M, Pumprla J, Schnider P (2000) Cardiac autonomic function in patients suffering from primary focal hyperhidrosis. Eur Neurol 44:112–116

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Senard JM, Simonetta-Moreau M, Tran MA (2003) Blood pressure and heart rate variability in patients with essential hyperhidrosis. Clin Auton Res 13:281–285

    Article  PubMed  Google Scholar 

  15. 15.

    Abraham P, Berthelot J, Victor J, Saumet JL, Picquet J, Enon B (2002) Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy. Ann Thorac Surg 74:2076–2081

    Article  PubMed  Google Scholar 

  16. 16.

    Wiklund U, Koskinen LO, Niklasson U, Bjerle P, Elfversson J (2000) Endoscopic transthoracic sympathicotomy affects the autonomic modulation of heart rate in patients with palmar hyperhidrosis. Acta Neurochir (Wien) 142:691–696

    CAS  Article  Google Scholar 

  17. 17.

    Kawamata YT, Kawamata T, Omote K, Homma E, Hanzawa T, Kaneko T, Namiki A (2004) Endoscopic thoracic sympathectomy suppresses baroreflex control of heart rate in patients with essential hyperhidrosis. Anesth Analg 98:37–39 (table of contents)

    Article  PubMed  Google Scholar 

  18. 18.

    Minson CT, Halliwill JR, Young TM, Joyner MJ (2000) Influence of the menstrual cycle on sympathetic activity, baroreflex sensitivity, and vascular transduction in young women. Circulation 101:862–868

    CAS  PubMed  Google Scholar 

  19. 19.

    Sato N, Miyake S, Akatsu J, Kumashiro M (1995) Power spectral analysis of heart rate variability in healthy young women during the normal menstrual cycle. Psychosom Med 57:331–335

    CAS  PubMed  Google Scholar 

  20. 20.

    Alvarenga ME, Richards JC, Lambert G, Esler MD (2006) Psychophysiological mechanisms in panic disorder: a correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables. Psychosom Med 68:8–16

    Article  PubMed  Google Scholar 

  21. 21.

    Kingwell BA, Thompson JM, Kaye DM, McPherson GA, Jennings GL, Esler MD (1994) Heart rate spectral analysis, cardiac norepinephrine spillover, and muscle sympathetic nerve activity during human sympathetic nervous activation and failure. Circulation 90:234–240

    CAS  PubMed  Google Scholar 

  22. 22.

    Moak JP, Goldstein DS, Eldadah BA, Saleem A, Holmes C, Pechnik S, Sharabi Y (2007) Supine low-frequency power of heart rate variability reflects baroreflex function, not cardiac sympathetic innervation. Heart Rhythm 4:1523–1529

    Article  PubMed  Google Scholar 

  23. 23.

    Sleight P, La Rovere MT, Mortara A, Pinna G, Maestri R, Leuzzi S, Bianchini B, Tavazzi L, Bernardi L (1995) Physiology and pathophysiology of heart rate and blood pressure variability in humans: is power spectral analysis largely an index of baroreflex gain? Clin Sci (Lond) 88:103–109

    CAS  Google Scholar 

Download references


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 Information on Reengineering the Clinical Research Enterprise can be obtained from The authors thank Pamela A. Engrav and Nicolee C Fode Thomas, for their recruiting efforts, and all of the patients for their enthusiastic participation.

Conflict of interest


Author information



Corresponding author

Correspondence to John H. Eisenach.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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).

Download citation


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