Thoracoscopic T2 Sympathicotomy Effects on QT Interval

Shin, Cheung Soo; Lee, Youn Woo; Kim, Jung Lyul; Jung, Chai Il; Lee, Jung Bok

Abstract

BACKGROUND: Thoracoscopic sympathicotomy was, at first, thought to be a simple and safe method for treatment of hyperhydrosis. However, few studies refer to the cardiac effects of this procedure, despite the fact that the T2 ganglia are in the direct pathway of the sympathetic innervation of the heart. An imbalance of right and left sympathetic efferent activity has been proposed as a mechanism for arrhythmia in patients with long QT syndrome. The aim of this study was to compare hemodynamic effect as well as ECG changes after right and left side sympathicotomy.
METHODS
42 patients with essential hyperhydrosis in ASA physical status class 1 undergoing thoracoscopic sympathicotomy were randomly divided into two groups: left side first operation group (group L, n = 22) and right side first operation group (group R, n = 20). Anesthesia was induced with thiopental sodium (5 mg/kg) and pancuronium (0.05 mg/Kg) and maintained with enflurane. During the procedure, we recorded blood pressure at both forearms and heart rate and ECG were recorded after anesthetic induction as baseline values, immediately after one side resectioned of sympathetic trunk, and after complete resectioning of both side. All operations were done with usual methods by experienced surgeons. All the records were coded and analysed singl blind by one author.
RESULTS
After sympathicotomy, there was a significant decrease in heart rate but not in blood pressure. However, statistically there were no significant changes in QT interval during sympathicotomy either right side first operation or left side first operation.
CONCLUSIONS
The main result of this study was that there were no significant changes in QT interval during sympathicotomy of either right or left side first operations. However, This does not mean that there was no possibility of prolongation of QT interval during thoracoscopic sympathicotomy. Careful observation of QT interval changes is needed during sympathicotomy.