CHANGES IN CARDIOCIRCULATORY AUTONOMIC FUNCTION AFTER THORACOSCOPIC UPPER DORSAL SYMPATHICOLYSIS FOR ESSENTIAL HYPERHIDROSIS

Essential hyperhidrosis (EH) is caused by an unexplained overactivity of the sympathetic fibers which pass through the upper dorsal sympathe tic ganglia D2 and D3. Since the D2 and D3 ganglia are also involved i n the sympathetic cardiac innervation, cardiocirculatory autonomic fun ction may also be abnormal in EH. In order to study the function of th e sympathetic nervous system in EH, and to assess the effects of thora coscopic sympathicolysis, cardiocirculatory autonomic function tests w ere performed in 13 consecutive patients with EH, before (baseline) an d 6 weeks after the thoracoscopic intervention. Baseline data were als o compared with data obtained from 13 matched healthy volunteers: EH p atients showed an increased heart rate at rest, but only in the standi ng position (94 +/- 18.5 vs 78 +/- 10.9 bpm, P < 0.01), as well as an increased ratio of low to high frequency power of the heart rate varia bility in the standing position (5.92 +/- 4.4 vs 2.8 +/- 2.5, P < 0.05 ). Exercise tests were normal in every EH patient. After sympathicolys is, hear? rate at rest (sitting on the cycloergometer) had decreased ( 75.4 +/- 13 vs 90.4 +/- 16.5 bpm, P < 0.05), as well as heart rate at maximal exercise (165.2 +/- 14.8 vs 180 +/- 10 bpm, P < 0.05). Exercis e capacity and the cardiorespiratory responses to exercise were, howev er, unchanged after sympathicolysis. Resting heart rate in the lying ( 66 +/- 10 vs 76 +/- 15 bpm, P < 0.05) and standing positions (82 +/- 1 3.8 vs 94 +/- 18.5 bpm, P < 0.05), and the diastolic blood pressure re action to a handgrip test (73.6 +/- 8.6 vs 84.7 +/- 11.6 mmHg, P < 0.0 5) were also lowered after sympathicolysis. In conclusion, patients wi th EH show an overfunctioning of the sympathetic system which is chara cterised by an increased reaction to stress (standing, exercise), wher eas resting sympathetic tone is unaffected. Thoracoscopic D2-D3 sympat hicolysis corrects this hyperfunction and has a partial beta-blocker-l ike activity, which results in a decrease in heart rate at rest and du ring maximal exercise, and in the diastolic blood pressure response to the handgrip test. Further studies are needed to assess the long-term consequences of this procedure.