Sympathectomy for Cardiac Arrhythmias: Historical Evolution and 21st Century Resurgence

Throughout the past 20 years, sympathectomy has garnered newfound interest for refractory cardiac arrhythmias. This study reviews its history and the evidence for its role in managing cardiac arrhythmias. A Scopus search was performed using the search term "sympathectomy" from 1904 to 2024. Article key terms were analyzed, and the Kendall rank correlation test was used to assess publication trends in the 5 most published domains. 16,507 articles were returned. The top 5 domains were hyperhidrosis (n = 766 publications), hypertension (n = 682), renal pathology (n = 627), cardiac arrhythmias (n = 277), and digital ischemic pathology (n = 201). Over the past 24 years, cardiac publications showed a positive trend (τ = 0.73, P < 0.001), while renal (τ = 0.51, P < 0.001), and hypertension (τ = 0.55, P < 0.001) showed stable trends. Hyperhidrosis (τ = 0.082, P = 0.59) and digital ischemia (τ = -0.077, P = 0.62) remained unchanged. While there has been a notable resurgence of sympathectomy for refractory cardiac arrhythmias, there remains a gap in the literature offering guidelines for patient selection. Recent studies have explored the association between arrhythmias and broader dysautonomia dysfunction, and proposed dysautonomia scores as a potential factor when considering sympathectomy candidacy. Future work should explore genetic risk factors that may drive treatment response and report long-term follow-up outcomes of cases and controls.