Long-term effect of endoscopic transthoracic sympathicotomy on heart rate variability and QT dispersion in severe angina pectoris

Tygesen, Hans; Wettervik, Christer; G, Claes; Drott, Christer; Emanuelsson, Håkan; Solem, Jens; Lomsky, Milan; Rådberg, Göran; Wennerblom, Bertil

doi:10.1016/s0167-5273(99)00101-1

Cited by 28 publications

(24 citation statements)

References 45 publications

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“…Tygesen et al have reported that changes in heart rate variability, which indicates significantly reduced sympathetic and increased vagal tone, and the reduction of QT dispersion both persisted for 2 years after ETS. 30 The present study demonstrated that blunted heart rate and the rate -pressure product responses to exercise by ETS persisted for at least 1 year. Although we cannot draw definite conclusions regarding the lasting effects of ETS on the cardiovascular system because of the small number of patients studied, the effect of ETS on the cardiovascular system as well as on palmar hyperhidrosis seems to continue for several years.…”

Section: Fig 2 Effects Of Endoscopic Transthoracic Sympathicotomy (Ets)supporting

confidence: 61%

Effects of Endoscopic Transthoracic Sympathicotomy on Hemodynamic and Neurohumoral Responses to Exercise in Humans.

Nakamura

Fujimoto

Nagata

et al. 2002

Circ J

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ndoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves and has been used successfully in the treatment of palmar hyperhidrosis, causalgia, or ischemia of the upper extremities. 1,2 Because of its minimal morbidity and mortality, renewed interest has been expressed in ETS as a palliative approach to patients with severe angina pectoris, who are not suitable for coronary artery bypass grafting or angioplasty. 3,4 Anatomically, the upper third or fourth thoracic, stellate, and cervical sympathetic ganglia receive the preganglionic fibers from the upper 4 thoracic segments of the spinal cord and direct the postganglionic fibers to the targets, including the heart, the upper extremities, and the cranial vessels. 5 Endoscopic transthoracic sympathicotomy blocks efferent sympathetic nerves to the heart as well as the upper extremities; however, the effect of ETS on the cardiovascular system remains unclear. The purpose of the present study was to examine the effect of Th 2-3 ETS on hemodynamic and neurohumoral responses to exercise in patients with palmar hyperhidrosis. Methods Patient SelectionTwenty-one patients with primary palmar hyperhidrosis Circulation Journal Vol.66, April 2002(10 males and 11 females, mean age 28±3 years; mean ± SEM) participated in the study. None of these patients had cardiac disease nor were receiving any drug that might affect autonomic function directly or indirectly. All patients gave their informed consent before participating. Endoscopic Transthoracic SympathicotomyThe operative technique, which has been described in detail elsewhere, 2,6 has been used in more than 400 patients with palmar hyperhidrosis at National Kanazawa Hospital since 1993. Patients were intubated with an endotracheal tube under general anesthesia and placed in a semireclining position with both arms in abduction. (In the semireclining position, the pneumothorax is located in the apical region.) Approximately 2 liters of carbon dioxide was insufflated into the pleural cavity through a Surgineedle entered via the axillary fossa. A modified urological electroresectoscope was introduced via the same incision into the axillary fossa, thus obtaining an excellent view of the upper thoracic cavity. The sympathetic chain can be identified lying over or in the immediate vicinity of the costovertebral joint. The second and third thoracic sympathetic ganglia, including rami communicantes, were destroyed by electrocautery. After exsufflation of the gas, the procedure was repeated on the opposite side. Operation time was within 30 min. The patient was discharged from hospital the day after operation and the hospital stay was 2 days. Most patients resumed work within a few days and resumed sports activities within 2 weeks. Treadmill Exercise TestSubmaximal, graded, upright treadmill exercise was performed according to a modified Bruce protocol comprising Circ J 2002; 66: 357 -361 (Received July 25, 2001; revised manuscript received December 11, 2001; accepted January 10, 20...

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Section: Fig 2 Effects Of Endoscopic Transthoracic Sympathicotomy (Ets)supporting

confidence: 61%

Effects of Endoscopic Transthoracic Sympathicotomy on Hemodynamic and Neurohumoral Responses to Exercise in Humans.

Nakamura

Fujimoto

Nagata

et al. 2002

Circ J

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“…In the present study, the observed increases in heart rate and Nor level show a progressive increase in sympathetic activity from baseline toward the application of Ϫ15 mmHg and then Ϫ40 mmHg LBNP. The decrease in QTd associated with the increase in sympathetic tone induced by the less intense stimulus is in contradiction with several other studies, because these showed an increase in QTd with sympathetic stimulation (21,23,46) that was reduced with the use of ␤-blockers (6,28,37). Considering that the reduction of VV and adrenergic activation have opposite effects on QTd, it is possible that the reduction of VV in our study prevailed over the autonomic activation and led to a decrease in QTd.…”

Section: Discussioncontrasting

confidence: 99%

Acute reduction of ventricular volume decreases QT interval dispersion in elderly subjects with and without heart failure

Carvalho

Consolim‐Colombo

Pastore

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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To evaluate the effects of acute reduction in ventricular volume (VV) on QT interval dispersion (QTd), 14 men with heart failure (HF; 74.5 Ϯ 2 yr of age) and 11 healthy male control subjects (68 Ϯ 2 yr of age) were studied. For 15 min, lower body negative pressure (LBNP) was applied at Ϫ15 and Ϫ40 mmHg to reduce venous return. At baseline and during LBNP application, QTd was measured with an 87-lead, body-surfacemapping device; chamber volumes were assessed by radioisotope ventriculography; blood pressure (BP) and heart rate (HR) were continuously monitored; and blood samples were obtained for assessment of norepinephrine (Nor) levels. At Ϫ15 mmHg, LNBP application induced a significant decrease in VV but did not change BP and HR in both groups. In addition, Nor levels increased significantly (P Յ 0.05) in the control group (from 286.7 Ϯ 31.5 to 388.8 Ϯ 41.2 pg/ml) and in HF patients (from 405.8 Ϯ 56 to 477.6 Ϯ 47 pg/ml), and QTd was significantly (P Յ 0.05) decreased in the control group (57.2 Ϯ 3.8 vs. 49.1 Ϯ 3.4 ms) and in HF patients (67.8 Ϯ 6 vs. 63.7 Ϯ 5.9 ms). No additional decreases in VV or QTd were produced by Ϫ40 mmHg LNBP, but Nor levels did increase in both groups and reach 475.5 Ϯ 34 and 586.5 Ϯ 60 pg/ml (P Ͻ 0.05) in the control and HF groups, respectively; BP did not change, but HR also increased in both groups. In conclusion, an acute LBNP-induced reduction in VV caused a decrease in the QTd of elderly men regardless of the existence of HF. Because increased sympathetic activity with more intense LBNP was not accompanied by additional changes in QTd, altered QTd may be better related to changes in VV than to autonomic nervous system activity. lower body negative pressure; cardiomyopathy; cardiac; norepinephrine; ischemic disease HEART FAILURE (HF) is a highly prevalent and important cause of morbidity and mortality in the elderly population (20). Although improvements in HF therapy have lowered mortality caused by disease progression, nearly half of the patients with HF experience sudden death (22,34). Some studies (4,7,12,14,39) have suggested that QT interval dispersion (QTd) could be associated with a higher risk of sudden death. Indeed, some investigators (16, 44) have correlated structural alterations observed in HF with increased QTd and a worse prognosis. Thus a better prognosis due to the use of drugs that attenuate ventricular remodeling [e.g., angiotensin-converting enzyme (ACE) inhibitors] seems to be associated with a more homogeneous repolarization, which leads to a decrease in QTd (3).As a result, research to detect a possible relationship between QTd behavior and factors known to influence the prognosis of HF [e.g., ventricular dysfunction, ventricular volume (VV), and neurohormonal activation] can be very useful (1, 35). Among such factors, VV is the least complex variable to study. One model that induces acute reductions in VV consists of the application of lower body negative pressure (LBNP), whereby cardiac preload is decreased because of a reduction in venous return (10). Thi...

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“…Bilateral endoscopic thoracic sympathectomy has been performed for the treatment of primary hyperhidrosis 3,4 and as a palliative approach to patients with severe angina pectoris 5 . Furthermore, left cardiac sympathetic denervation is described situation that can potentially provide clinical and ventricular function benefits without paradoxical deleterious effects.…”

Section: Introductionmentioning

confidence: 99%

“…Recent studies have demonstrated that these procedures decrease sympathetic nervous activity 5,[8][9][10] , while vagal and global cardiac autonomic functions seem to be improved after them 8 . The most significant effects on cardiac sympathetic activity seem to be particularly related to the excision or blockade of the left stellate ganglion and subsequent sympathetic chain 11 .…”

mentioning

confidence: 99%

Bloqueio simpático esquerdo por videotoracoscopia no tratamento da cardiomiopatia dilatada

Pêgo-Fernandes¹,

Moreira²,

Souza³

et al. 2010

Arq. Bras. Cardiol.

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Long-term effect of endoscopic transthoracic sympathicotomy on heart rate variability and QT dispersion in severe angina pectoris

Cited by 28 publications

References 45 publications

Effects of Endoscopic Transthoracic Sympathicotomy on Hemodynamic and Neurohumoral Responses to Exercise in Humans.

Effects of Endoscopic Transthoracic Sympathicotomy on Hemodynamic and Neurohumoral Responses to Exercise in Humans.

Acute reduction of ventricular volume decreases QT interval dispersion in elderly subjects with and without heart failure

Bloqueio simpático esquerdo por videotoracoscopia no tratamento da cardiomiopatia dilatada

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