Skin sympathetic nerve activity as a biomarker for syncopal episodes during a tilt table test

Kumar, Amarendra; Wright, Keith; Uceda, Domingo E.; Vasallo, Peter; Rabin, Perry Lee; Adams, David; Wong, Johnson; Das, Mithilesh K.; Lin, Shien Fong; Chen, Peng Sheng; Everett, Thomas H.

doi:10.1016/j.hrthm.2019.10.008

Cited by 10 publications

(6 citation statements)

References 18 publications

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“…There are also no oral agents that can safely and effectively reduce cardiac vagal tone for a long time. Previous studies have known that the autonomic nervous system imbalance affects the automaticity of the sinoatrial node, causing sinus bradycardia, sinus arrest, atrioventricular block, and other types of bradycardias 22 , 23 . Vagus bradycardia is one of the diseases that cause autonomic nervous system imbalance due to abnormal increase of vagal excitability 24 , 25 .…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of cardioneuroablation for vagal bradycardia in a single arm prospective study

Han,

Shao,

Yang

et al. 2024

Sci Rep

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Cardioneuroablation (CNA) is currently considered as a promising treatment option for patients with symptomatic bradycardia caused by vagotonia. This study aims to further investigate its safety and efficacy in patients suffering from vagal bradycardia. A total of 60 patients with vagal bradycardia who underwent CNA in the First Affiliated Hospital of Xinjiang Medical University from November 2019 to June 2022. Preoperative atropine tests revealed abnormal vagal tone elevation in all patients. First, the electroanatomic structures of the left atrium was mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram-guided CNA methods. The upper limit of ablation power of superior left ganglion (SLGP) and right anterior ganglion (RAGP) was not more than 45W with an ablation index of 450.Postoperative transesophageal cardiac electrophysiological examination was performed 1 to 3 months after surgery. The atropine test was conducted when appropriate. Twelve-lead electrocardiogram, Holter electrocardiogram, and skin sympathetic nerve activity were reviewed at 1, 3, 6 and 12 months after operation. Adverse events such as pacemaker implantation and other complications were also recorded to analyze the safety and efficacy of CNA in the treatment of vagus bradycardia. Sixty patients were enrolled in the study (38 males, mean age 36.67 ± 9.44, ranging from 18 to 50 years old). None of the patients had a vascular injury, thromboembolism, pericardial effusion, or other surgical complications. The mean heart rate, minimum heart rate, low frequency, low/high frequency, acceleration capacity of rate, and skin sympathetic nerve activity increased significantly after CNA. Conversely, SDNN, PNN50, rMSSD, high frequency, and deceleration capacity of rate values decreased after CNA (all P < 0.05). At 3 months after ablation, the average heart rate, maximum heart rate, and acceleration capacity of heart rate remained higher than those before ablation, and the deceleration capacity of heart rate remained lower than those before ablation and the above results continued to follow up for 12 months after ablation (all P < 0.05). There was no significant difference in other indicators compared with those before ablation (all P > 0.05). The remaining 81.67% (49/60) of the patients had good clinical results, with no episodes of arrhythmia during follow-up. CNA may be a safe and effective treatment for vagal-induced bradycardia, subject to confirmation by larger multicenter trials.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of cardioneuroablation for vagal bradycardia in a single arm prospective study

Han,

Shao,

Yang

et al. 2024

Sci Rep

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“…However, one of the limitations of the skNA sensor is the inability to gauge parasympathetic activity. 39 …”

Section: Discussionmentioning

confidence: 99%

Automatic Detection and Characterization of Autonomic Dysreflexia Using Multi-Modal Non-Invasive Sensing and Neural Networks

Suresh

Everett

Shi

et al. 2022

Neurotrauma Reports

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Autonomic dysreflexia (AD) frequently occurs in persons with spinal cord injuries (SCIs) above the T6 level triggered by different stimuli below the level of injury. If improperly managed, AD can have severe clinical consequences, even possibly leading to death. Existing techniques for AD detection are time-consuming, obtrusive, lack automated detection capabilities, and have low temporal resolution. Therefore, a non-invasive, multi-modal wearable diagnostic tool was developed to quantitatively characterize and distinguish unique signatures of AD. Electrocardiography and novel skin nerve activity (skNA) sensors with neural networks were used to detect temporal changes in the sympathetic and vagal systems in rats with SCI. Clinically established metrics of AD were used to verify the onset of AD. Five physiological features reflecting different metrics of sympathetic and vagal activity were used to characterize signatures of AD. An increase in sympathetic activity, followed by a lagged increase in vagal activity during the onset of AD, was observed after inducing AD. This unique signature response was used to train a neural network to detect the onset of AD with an accuracy of 93.4%. The model also had a 79% accuracy in distinguishing between sympathetic hyperactivity reactions attributable to different sympathetic stressors above and below the level of injury. These neural networks have not been used in previous work to detect the onset of AD. The system could serve as a complementary non-invasive tool to the clinically accepted gold standard, allowing an improved management of AD in persons with SCI.

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“…The burst amplitude is correlated to both skin blood flow reduction rate and sweat rate change. As a non‐invasive sympathetic activity assessment method, SSNA has been widely used to predict sympathetic tone in cardiac diseases, neurological disorders, sleep apnea, etc 112–116 . The ICH classification and outcome prediction based on the SSNA signal had been proved to be a feasible method 114 .…”

Section: Assessmentmentioning

confidence: 99%

“…Skin sympathetic nerve activity (SSNA) is microneurographically recorded from the skin nerve fascicle in the peripheral nerves, which is characterized by burst activity followed by vasoconstriction and/or sweating, and usually elicited by mental stress and arousal stimulation. 112 , 113 , 114 It comprises vasoconstrictor (VC), sudomotor (SM) activity, and vasodilator (VD) activity. The burst amplitude is correlated to both skin blood flow reduction rate and sweat rate change.…”

Section: Assessmentmentioning

confidence: 99%

Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

Kang,

Shi,

Liu

et al. 2024

CNS Neurosci Ther

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AimsAutonomic dysfunction with central autonomic network (CAN) damage occurs frequently after intracerebral hemorrhage (ICH) and contributes to a series of adverse outcomes. This review aims to provide insight and convenience for future clinical practice and research on autonomic dysfunction in ICH patients.DiscussionWe summarize the autonomic dysfunction in ICH from the aspects of potential mechanisms, clinical significance, assessment, and treatment strategies. The CAN structures mainly include insular cortex, anterior cingulate cortex, amygdala, hypothalamus, nucleus of the solitary tract, ventrolateral medulla, dorsal motor nucleus of the vagus, nucleus ambiguus, parabrachial nucleus, and periaqueductal gray. Autonomic dysfunction after ICH is closely associated with neurological functional outcomes, cardiac complications, blood pressure fluctuation, immunosuppression and infection, thermoregulatory dysfunction, hyperglycemia, digestive dysfunction, and urogenital disturbances. Heart rate variability, baroreflex sensitivity, skin sympathetic nerve activity, sympathetic skin response, and plasma catecholamine concentration can be used to assess the autonomic functional activities after ICH. Risk stratification of patients according to autonomic functional activities, and development of intervention approaches based on the restoration of sympathetic‐parasympathetic balance, would potentially improve clinical outcomes in ICH patients.ConclusionThe review systematically summarizes the evidence of autonomic dysfunction and its association with clinical outcomes in ICH patients, proposing that targeting autonomic dysfunction could be potentially investigated to improve the clinical outcomes.

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Skin sympathetic nerve activity as a biomarker for syncopal episodes during a tilt table test

Cited by 10 publications

References 18 publications

Safety and efficacy of cardioneuroablation for vagal bradycardia in a single arm prospective study

Safety and efficacy of cardioneuroablation for vagal bradycardia in a single arm prospective study

Automatic Detection and Characterization of Autonomic Dysreflexia Using Multi-Modal Non-Invasive Sensing and Neural Networks

Autonomic dysfunction and treatment strategies in intracerebral hemorrhage

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