Skin sympathetic nerve activity precedes the onset and termination of paroxysmal atrial tachycardia and fibrillation

Background Intrinsic cardiac nerve activities (ICNA) and the skin nerve activities (SKNA) are both associated with cardiac arrhythmias in dogs. Objective To test the hypothesis that ICNA and SKNA correlate with postoperative cardiac arrhythmias in humans. Methods Eleven patients (60±13 years old; 4 female) were enrolled in this study. Electrical signals were simultaneously recorded from electrocardiogram (ECG) patch electrodes on the chest wall and from two temporary pacing wires placed during open heart surgery on the left atrial epicardial fat pad. The signals were filtered to display SKNA and ICNA. Premature atrial contractions (PAC) and premature ventricular contractions (PVC) were manually determined. The SKNA and ICNA of the first 300 min of each patient were calculated min-by-min to determine baseline average amplitudes of nerve activities and to determine their correlation with arrhythmia burden. Results We processed 1365±973 min of recording per patient. Low-amplitude SKNA and ICNA were present at all time, while the burst discharges were observed much less frequently. Both SKNA and burst ICNA were significantly associated with the onset of PACs and PVCs. Baseline average ICNA (aICNA), but not SKNA (aSKNA), had a significant association with PAC burden. The correlation coefficient (r) between aICNA and PAC burden was 0.78 (P<0.01). A patient with the greatest aICNA developed postoperative atrial fibrillation. Conclusions ICNA and SKNA can be recorded from human patients in the postoperative period. Baseline magnitude of ICNA correlates with PAC burden and development of postoperative atrial fibrillation.

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“…In contrast, elevated aSKNA was strongly associated with paroxysmal atrial tachyarrhythmias that occur without preceding open heart surgery. 21 …”

Section: Discussionmentioning

confidence: 99%

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

et al. 2017

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“…31 Our recent studies showed that SKNA could be detected in humans using conventional patch electrodes using a recording system with high sampling rate and wide frequency bandwidth. 32, 33 High pass filtering could eliminate the ECG signals and retain high frequency signals that included both muscle and nerve activities. Like most diagnostic tests, specificity could be increased only at the cost of reduction in sensitivity and vice versa.…”

Section: Discussionmentioning

confidence: 99%

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

et al. 2017

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Background We recently reported that the skin sympathetic nerve activity (SKNA) can be used to estimate the sympathetic tone in humans. In animal models, vagal nerve stimulation (VNS) can damage the stellate ganglion, reduce stellate ganglion nerve activity and suppress cardiac arrhythmia. Whether or not VNS can suppress sympathetic tone in humans remain unclear. Objective To test the hypothesis that VNS suppresses SKNA in patients with drug resistant epilepsy. Methods We used electrocardiogram (ECG) patch electrodes to continuously record SKNA in 26 patients with drug resistant epilepsy who were admitted for video electroencephalographic monitoring. Among them, 6 (2 men, age 40±11 years) were previously treated with VNS and 20 (7 men, age 37±8 years) did not. The signals from ECG leads I and II were filtered to detect SKNA. Results The VNS had an ON-time of 30 s and OFF-time of 158±72 s, with output of 1.92±0.42 mA at 24.17±2.01 Hz. The average SKNA (aSKNA) during VNS OFF-time was 1.06 μV [95% confidence interval, CI, 0.93 to 1.18] in lead I and 1.13 μV [CI, 0.99 to 1.27] in lead II, which was significantly lower than 1.38 μV [CI, 1.01 to 1.75, p=0.036] and 1.38 μV [CI, 0.98 to 1.78, p=0.035] of the control Group, respectively. The heart rate was 65 bpm [CI, 59 to 71] in VNS group, significantly lower than 77 bpm [95% CI, 71 to 83] in control group. Conclusion Patients with VNS had significantly lower SKNA than patients without VNS.

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“…The role of ANS on cardiac arrhythmogenesis was evaluated by direct recording of autonomic nerve activity in ambulatory animals 12,13 and in humans. 14,15 There was circadian variation in the sympathetic outflow from the canine stellate ganglia. Simultaneous sympathovagal discharges often precede paroxysmal atrial tachycardia (AT) events.…”

Section: Direct Recording Of the Ans And Atrial Tachyarrhythmiamentioning

confidence: 99%

Ganglionated plexi as neuromodulation targets for atrial fibrillation

Choi

Zhao

Everett

et al. 2017

Cardiovasc electrophysiol

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The autonomic nervous system plays an important role in the genesis of atrial fibrillation and is one of the candidate targets for atrial fibrillation therapy. This review focuses on the role of the autonomic nervous system in atrial fibrillation development and discusses the results of the ganglionated plexi catheter and surgical ablation in preclinical and clinical studies. The heart is innervated by the extrinsic and intrinsic autonomic nervous systems. The intrinsic autonomic nervous system consists of multiple ganglionated plexi and axons, which innervate the neighboring atrial myocardium and control their electrophysiological properties. Abnormal autonomic innervation has been observed in an animal model of atrial fibrillation and in humans. Direct recordings of autonomic nerve activity in canine models showed that atrial tachyarrhythmia episodes were invariably preceded by intrinsic cardiac autonomic nerve activity, thus supporting the importance of intrinsic cardiac autonomic nerve activity as the triggers for atrial tachyarrhythmia. Targeting ganglionated plexi with catheter ablation improves the outcomes of paroxysmal atrial fibrillation ablation in addition to pulmonary vein antrum isolation. Ablation of ganglionated plexi alone without pulmonary vein isolation is also useful in controlling paroxysmal atrial fibrillation in some patients. However, surgical ganglionated plexi ablation in patients with a large left atrium, persistent atrial fibrillation and/or a history of prior catheter ablation does not result in additional benefits. These different outcomes suggest that ganglionated plexi ablation is effective in managing patients with paroxysmal atrial fibrillation, but its effects in patients with persistent atrial fibrillation and advanced atrial diseases might be limited.

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Skin sympathetic nerve activity precedes the onset and termination of paroxysmal atrial tachycardia and fibrillation

Cited by 59 publications

References 34 publications

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

Simultaneous recordings of intrinsic cardiac nerve activity and skin sympathetic nerve activity from human patients during the postoperative period

Left cervical vagal nerve stimulation reduces skin sympathetic nerve activity in patients with drug resistant epilepsy

Ganglionated plexi as neuromodulation targets for atrial fibrillation

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