Endoscopic transthoracic sympathicotomy (ETS) is a recently developed technique to divide sympathetic nerves. ETS has been shown to improve symptoms and reduce ischemia in patients with severe angina pectoris. Low heart rate variability (HRV) in patients with ischemic heart disease carries an adverse prognosis. HRV reflects autonomic response of the heart and a shift in the sympathovagal balance towards parasympathetic dominance could be a marker of improved prognosis. HRV might also be used as an indicator of surgical success in sympathetic heart denervation. Heart rate was recorded in 57 patients before and after ETS. Registration was recorded during controlled respiration in the supine position and at tilt test over 10 minutes and spectral analysis was performed. Twenty-four hour Holter recordings were analyzed in the time domain. During the controlled setting, the high-frequency (HF) component (0.15 to 0.40 Hz) increased significantly whereas the low-frequency (LF) component (0.04 to 0.15 Hz) did not change significantly. The LF/HF ratio at tilt test was reduced from 1.3 to 0.8 (p <0.01). The time-domain analysis showed a significant increase of the mean RR interval (923 to 1,006 ms, p <0.001) and indexes reflecting parasympathetic tone also increased significantly (the root-mean square of difference measured from 24.3 to 29.5 ms, p <0.001 and the proportion of adjacent RR intervals >50% measured from 5.5% to 8.2%, p <0.01), whereas measurements reflecting global HRV did not change. In addition to relief of symptoms and reduced ischemia in severe angina pectoris, ETS caused a shift of sympathovagal balance toward parasympathetic tone. This might explain the anti-ischemic effect and have prognostic implications.

译文

内窥镜经胸交感神经切开术(ETS)是一种新近开发的用于分割交感神经的技术。 ETS已显示可改善重度心绞痛患者的症状并减少缺血。缺血性心脏病患者的低心率变异性(HRV)会带来不利的预后。 HRV反映了心脏的自主神经反应,交感神经平衡向副交感性优势的转变可能是预后改善的标志。 HRV也可以用作交感神经去神经术手术成功的指标。 ETS前后有57例患者记录了心率。在仰卧位的受控呼吸过程中和10分钟的倾斜测试中记录配准,并进行光谱分析。在时域中分析了二十四小时的动态心电记录。在受控设置期间,高频(HF)分量(0.15至0.40 Hz)显着增加,而低频(LF)分量(0.04至0.15 Hz)没有显着变化。倾斜测试的LF / HF比从1.3降低到0.8(p <0.01)。时域分析显示平均RR间隔显着增加(923至1,006 ms,p <0.001),反映副交感神经张力的指标也显着增加(差异的均方根从24.3上升至29.5 ms,p <0.001而相邻RR间隔> 50%的比例从5.5%降至8.2%,p <0.01),而反映总体HRV的测量值没有变化。除了缓解症状和减轻严重心绞痛的局部缺血外,ETS还引起交感神经平衡向副交感神经的转变。这可能解释了抗缺血作用并具有预后意义。

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