CARDIAC EFFECTS OF ENDOSCOPIC ELECTROCAUTERY OF THE UPPER THORACIC SYMPATHETIC CHAIN

Bilateral endoscopic electrocautery of the upper thoracic sympathetic ganglia (T-2-4) was performed, mainly for palmar hyperhidrosis, on 535 patients. The aim of this study was to evaluate the effects of this p rocedure on cardiac and physical performance. A subgroup of 18 patient s underwent cycle ergometer test with ECG recordings before and three months after surgery. After the operation, a significantly reduced hea rt rate at rest (12%) as well as during excercise and during recovery after excercise was found. The systolic blood pressure was reduced onl y 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 wit h 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 consitute an alternativ e to long-term thoracic epidural anaesthesia and implantation of thora cic electric stimulation devices in patients not suited for aortocoron ary by-pass. Patients who require cardiac Preceptor blockers and suffe r from side effects of these drugs might also benefit from surgical ca rdiac sympathetic denervation.