Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side

P. Abraham, , a, J. Picquetb, S. Bickerta, X. Paponb, Y. Joussetb, J. L. Saumeta and B. Enonb

The authors conclude that having ETS causes heart problems, even if they only operate on one side. For the entire article, go here.

a] Department of Vascular Investigations and Sports Medicine, University Hospital, 49033 Angers cedex 01, France

b] Department of Cardio-Vascular and Thoracic surgery, University Hospital, 49033 Angers cedex 01, France
Received 16 May 2001; revised 10 August 2001; accepted 4 September 2001 Available online 14 November 2001.

Abstract

Objective: Removal of accessory fibres coming from the sub-stellar thoracic chain to the heart during infra-stellate surgical upper thoracic sympathectomy (ISS) may be responsible for a decreased heart rate to workload relationship during exercise following surgery. We hypothesised that heart rate would decrease not only following right ISS. Methods: We performed repeated bicycle incremental exercise tests in 11 control subjects (26.9±9.5 years, 61.4±12.4 kg, 167±10 cm), and 11 patients (29.8±10 years, 59.3±12.0 kg, 168±7 cm) referred for bilateral ISS: results are mean±standard deviation. Surgery was performed at two distinct times allowing to study the consequences of unilateral and bilateral sympathectomy to confirm whether a significant relative bradycardia was constant and dependent on the operated side. Results: For control subjects, test durations were 13.55±3.29, 14.09±4.01 and 13.00±3.26 min and heart rates were 187±7, 187±8 and 186±7 beats min-1 at the first, second and third test, respectively. Although time to exhaustion was comparable to controls and unchanged between tests: 12.32±2.87, 12.3±2.90, 12.33±3.76 min, heart rate at maximum exercise decreased significantly from 176±16 to 164±15, and 148±15 beats min-1, before, following unilateral and bilateral ISS, respectively. The operated side did not allow for the prediction of the effect of unilateral sympathectomy. Conclusions: Patients should be informed of the exercise bradycardia resulting from ISS, although clinical tolerance seems excellent in endurance exercise. Contrary to previous reports at rest, during exercise no right-sided dominance was observed. These findings are consistent with reports of random distribution of sub-stellate cardiac fibres from anatomical studies.