D. Perdomo1, A. Leng1, J.S. Ha1 1The Johns Hopkins University School Of Medicine, Division Of Thoracic Surgery, Baltimore, MD, USA
Introduction: As the anatomic and physiologic understanding of the autonomic nervous system grew throughout the 1800s, surgical procedures aimed at modulating its effects were subsequently developed. In 1889, the first sympathectomy was performed for a case of epilepsy, and soon after for various conditions including hyperhidrosis. In the past 20 years, the procedure has garnered newfound interest for recalcitrant cardiac arrhythmias. The aim of this study is to review the history of sympathectomy and trends in its indications to better understand the evidence for its use in managing cardiac arrhythmias.
Methods: A Scopus search was performed using the search term "sympathectomy” from 1904 to 2024. Article key terms which occurred in more than 10 articles were analyzed to identify publication domains. The Kendall rank correlation coefficient test was used to analyze publication trends from 2000-2024 for the five most published domains; p<0.05 was considered significant.
Results: From 1904-2024, 16,507 articles were returned, of which 10,304 were human studies. From 1904-2024, the five most published domains referenced hyperhidrosis (n=766 publications), hypertension (n=682), renal pathology and denervation (n=627), cardiac arrhythmias (n=277), and digital ischemic pathology (n=201). In the past 24 years, there has been a significantly positive trend in the number of cardiac publications (τ=0.73, p<0.001) compared to a stable trend in renal (τ=0.51, p<0.001) and hypertension publications (τ=0.55, p= <0.001), and seemingly unchanged hyperhidrosis (τ=0.082, p=0.59) and digital ischemia (τ=-0.077, p=0.62) publication trends. Upon review of the 277 cardiac publications, there appears to be a growing interest in the study of recalcitrant cardiac arrythmias as a subset of dysautonomia and in identifying genetic mutations sympathetic dysregulation. Claims of the sympathectomy’s efficacy for these patients is limited by a paucity of long-term follow-up after the procedure.
Conclusion: In the 21st century, there has been a notable resurgence of sympathectomy and cardiac denervation for recalcitrant cardiac arrythmias. While the procedure offers promise to a pathology unresponsive to conventional management with pharmacological therapies and implantable devices, there is a significant gap in the literature offering guidelines for patient selection. If the procedure is to become more widely used, especially given the growth in academic interest, future studies should examine genetic risk factors and its association with broader autonomic dysautonomia. Furthermore, long-term follow-up of surgical cases compared to controls is needed to better assess sympathectomy’s efficacy for recalcitrant cardiac arrythmias.