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European Journal of Cardio-Thoracic Surgery 
Volume 20, Issue 6 , December 2001, Pages 1095-1100 
 
   
 
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doi:10.1016/S1010-7940(01)01002-8       
Copyright  2001 Elsevier Science B.V. All rights reserved. 
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 

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 (26.99.5 years, 61.412.4 kg, 16710 cm), and 11 patients (29.810 years, 59.312.0 kg, 1687 cm) referred for bilateral ISS: results are meanstandard 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 13.553.29, 14.094.01 and 13.003.26 min and heart rates were 1877, 1878 and 1867 beats min-1 at the first, second and third test, respectively. Although time to exhaustion was comparable to controls and unchanged between tests: 12.322.87, 12.32.90, 12.333.76 min, heart rate at maximum exercise decreased significantly from 17616 to 16415, and 14815 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. 

Author Keywords: Sympathectomy; Collateral effects; Palmar hyperhidrosis; Complications; Exercise; Bicycle; Heart rate 
 

 Corresponding author. Tel.: +33-241-35-3689; fax: +33-241-35-5042; email: explovasc@chu-angers.fr 
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Eur J Cardiothorac Surg 2001;20:1095-1100
 2001 Elsevier Science NL 

Infra-stellate upper thoracic sympathectomy results in a relative bradycardia during exercise, irrespective of the operated side 
P. Abrahama, J. Picquetb, S. Bickerta, X. Paponb, Y. Joussetb, J.L. Saumeta, B. Enonb 
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; received in revised form 10 August 2001; accepted 4 September 2001.

Corresponding author. Tel.: +33-241-35-3689; fax: +33-241-35-5042
e-mail: explovasc@chu-angers.fr


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 (26.99.5 years, 61.412.4 kg, 16710 cm), and 11 patients (29.810 years, 59.312.0 kg, 1687 cm) referred for bilateral ISS: results are meanstandard 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 13.553.29, 14.094.01 and 13.003.26 min and heart rates were 1877, 1878 and 1867 beats min-1 at the first, second and third test, respectively. Although time to exhaustion was comparable to controls and unchanged between tests: 12.322.87, 12.32.90, 12.333.76 min, heart rate at maximum exercise decreased significantly from 17616 to 16415, and 14815 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. 


Key Words: Sympathectomy  Collateral effects  Palmar hyperhidrosis  Complications  Exercise  Bicycle  Heart rate





