Cardiac effects of endoscopic electrocautery of the upper thoracic sympathetic chain

Bilateral endoscopic electrocautery of the upper thoracic sympathetic ganglia (T2-4) was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim of this study was to evaluate the effects of this procedure on cardiac and physical performance. A subgroup of 18 patients underwent cycle ergometer test with ECG recordings before and three months after surgery. After the operation, a significantly reduced heart rate at rest (12%) as well as during exercise and during recovery after exercise was found. The systolic blood pressure was reduced only at rest (7%) and the diastolic blood pressure was not significantly altered. Maximal workload was not affected by the operation and only a few patients had noticed their reduced heart rate. Three patients with angina pectoris and three with incapacitating tachycardia related to mental stress were operated on with excellent results. Thoracoscopic sympathicotomy is a safe, fast, cheap and efficient method for cardiac sympathetic denervation. This procedure might constitute an alternative to long-term thoracic epidural anaesthesia and implantation of thoracic electric stimulation devices in patients not suited for aortocoronary by-pass. Patients who require cardiac beta-receptor blockers and suffer from side effects of these drugs might also benefit from surgical cardiac sympathetic denervation.