Sympathetic activity–associated periodic repolarization dynamics predict mortality following myocardial infarction

Rizas, Konstantinos D.; Nieminen, Tuomo; Barthel, Petra; Zürn, Christine; Kähönen, Mika; Viik, Jari; Lehtimäki, Terho; Nikus, Kjell; Eick, Christian; Greiner, Tim O.; Wendel, Hans Peter; Seizer, Peter; Schreieck, Jürgen; Gawaz, Meinrad; Schmidt, Georg; Bauer, Axel

doi:10.1172/jci70085

Cited by 82 publications

(167 citation statements)

References 54 publications

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“…For survival analyses, PRD wavelet was dichotomised at the upper quartile of the study population. 17 The 5-year mortality rate in the group of the 227 patients with PRD wavelet ≥5.75 deg 2 was 18.2 % compared with 4.1 % in the 681 patients with PRD wavelet <5.75 deg 2 (P<0.001; see Figure 3B). In multivariable analyses PRD wavelet was revealed to be a strong predictor of mortality after MI and its predictive ability was independent from established risk predictors, such as left-ventricular ejection fraction (LVEF), the Global Registry of Acute Coronary Events (GRACE) score, presence of diabetes mellitus, reduced HRV and increased QT-variability index.…”

Section: Periodic Repolarisation Dynamics As a Risk Predictor After Mmentioning

confidence: 87%

“…17 So-called periodic repolarisation dynamics (PRD) evaluates sympathetic activity-associated lowfrequency periodic changes of cardiac repolarisation instability and opens new perspectives for identifying high-risk patients, who would potentially benefit from prophylactic interventions. The first section of this review briefly depicts the methodology of PRD assessments.…”

Section: Arrhythmia Mechanismsmentioning

confidence: 99%

“…17 In a first step, the ECG is converted to a set of polar coordinates defined by two angles (azimuth and elevation) and the 'resultantforce' amplitude (Amp). The beginning and ending of each T-wave are identified using previously published algorithms.…”

Section: Arrhythmia Mechanismsmentioning

confidence: 99%

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Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Rizas¹,

Hamm²,

Kääb³

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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Experimental and clinical studies have demonstrated that enhanced sympathetic autonomic nervous system (SANS) activity can destabilise myocardial repolarisation, 1-4 increasing vulnerability to developing fatal cardiac arrhythmias. [5][6][7][8] Accordingly, assessment of SANS activity has always been a major goal for cardiac risk stratification methods.Various non-invasive methods including assessment of heart rate variability (HRV) and baroreflex sensitivity have been employed to study the activity of the SANS under routine clinical conditions. 9 These methods are based on two principles. First, activation of the SANS evokes physiological effects on the cardiovascular system, such as acceleration of heart rate, increased vasomotor tone or systolic contractility.4 Second, as SANS activity is clustered in low-frequency bursts, SANS-induced physiological responses are likely to exhibit low-frequency dynamics. [10][11][12][13][14] Previous studies have shown that SANS assessment based on HRV and baroreflex sensitivity is a marker of increased vulnerability to fatal cardiac arrhythmias. 15,16 However, both methods are limited by the fact that they only provide an indirect probe of the sympathetic effect on cardiac repolarisation, as they reflect influences on the sinoatrial node and blood vessels and not on the ventricular myocardium. In addition, both HRV and baroreflex sensitivity are confounded by the concomitant action of other systems exhibiting periodic dynamics, such as the parasympathetic nervous system and the renin-angiotensinaldosterone system, respectively.We proposed a novel approach to SANS assessment that substantially differs from previous methods.17 So-called periodic repolarisation dynamics (PRD) evaluates sympathetic activity-associated lowfrequency periodic changes of cardiac repolarisation instability and opens new perspectives for identifying high-risk patients, who would potentially benefit from prophylactic interventions. The first section of this review briefly depicts the methodology of PRD assessments.The second section focuses on potential mechanisms of PRD. In the third section, the clinical application of PRD as risk predictor after myocardial infarction (MI) is presented. In the fourth section, we present an alternative method for PRD assessment, which provides some technical advantages over the standard method. The final sections are dedicated to ongoing and future projects aimed at developing individualised treatment strategies. Methodology of Periodic Repolarisation Dynamics AssessmentPRD is typically assessed using a high-resolution ECG recorded in or converted to the three orthogonal axes X, Y and Z ('Frank lead configuration'). As low-frequency patterns are of interest, the recording AbstractPeriodic repolarisation dynamics (PRD) refers to low-frequency (≤0.1Hz) modulations of cardiac repolarisation instability. Spontaneous PRD can be assessed non-invasively from 3D high-resolution resting ECGs. Physiological and experimental studies have indicated that PRD correlates with effere...

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Section: Periodic Repolarisation Dynamics As a Risk Predictor After Mmentioning

confidence: 87%

Section: Arrhythmia Mechanismsmentioning

confidence: 99%

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Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Rizas¹,

Hamm²,

Kääb³

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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“…Deceleration capacity (DC) and periodic repolarization dynamics (PRD) are novel ECG-based methods that are capable of separately assessing the vagal and sympathetic components of cardiac autonomic function [5] [6]. DC is an advanced measure of heart rate variability, thus basically analyzing autonomic innervation at the level of the sinus node.…”

Section: Measures Of Cardiac Autonomic Dysfunctionmentioning

confidence: 99%

Biosignal-guided personalized therapy

Stülpnagel

Wolf

Bauer

2017

Current Directions in Biomedical Engineering

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Sudden cardiac death (SCD) is the leading single cause of death in the industrialized world. Current guidelines recommend a prophylactic implantation of an implantable cardioverter-defibrillator (ICD) in patients with reduced leftventricular ejection fraction (LVEF ≤ 35%). However, most deaths after myocardial infarction (MI) occur in patients with normal or moderately reduced LVEF (>35%). There is a large body of evidence that cardiac autonomic dysfunction after MI is linked to increased susceptibility to malignant arrhythmias. Deceleration capacity of heart rate (DC) and periodic repolarization dynamics (PRD) are novel ECGbased risk markers, which capture different facets of cardiac autonomic dysfunction. Both parameters are strong and independent predictors of mortality and SCD after MI. Previous studies indicated that combined assessment of DC and PRD allows identification of a new high-risk group among post-infarction patients that is not addressed by current guidelines, thus opening new perspectives for biosignal-guided personalized therapies.

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“…Sympatho-vagal imbalance, especially the hyperexcitation is associated to the development of hypertension, cardiac arrhythmias and sudden death (Marmar & Shivkumar, 2008;Rizas et al, 2014). Therapeutic techniques that correct this imbalance are associated with reduced cardiovascular mortality (European Society of Cardiology [ESC], 1996).…”

Section: Introductionmentioning

confidence: 99%

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

Nardi¹,

Hauck²,

Franco³

et al. 2017

Acta Sci. Health Sci.

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ABSTRACT. This study aims to evaluate the effects of TENS at different frequencies on autonomic balance in healthy volunteers. It is a case-control study, and was composed of fourteen healthy volunteers (5 women) with 28 (3.9) years old who underwent low ) and high (100 Hz 200ms -1 ) frequency TENS. The interventions were randomized and applied for 30 minutes in the trajectory brachial nerve plexus from non-dominant member. Intensities were adjusted every 5 minutes and maintained below motor threshold. The autonomic balance was assessed before and after interventions by heart rate variability (HRV). TENS 10 Hz increased 10% sympathetic activity and decreased 10% parasympathetic activity; however, TENS 100 Hz showed opposite effects (p < 0.05). The sympatho-vagal balance increased with low frequency TENS and decreased with high frequency (p < 0.05). It can be concluded that different frequencies of TENS applied in the trajectory brachial nerve plexus modify cardiovascular autonomic responses. High frequency TENS reduces sympathetic activity and increases the parasympathetic, which favors beneficial effects on autonomic balance in healthy volunteers.Keywords: electric stimulation, autonomic nervous system, heart rate.Diferentes frequências da estimulação elétrica nervosa transcutânea no balanço simpatovagal RESUMO. Este estudo objetiva avaliar os efeitos de diferentes frequências da TENS sobre o balanço autonômico em voluntários saudáveis. Estudo caso-controle composto de quatorze voluntários saudáveis (5 mulheres), com 28 (3,9) anos de idade que foram submetidos a baixa (10 Hz 200 ms ) frequências da TENS. As intervenções foram randomizadas e aplicadas por 30 minutos sobre a trajetória do plexo nervoso braquial do membro não dominante. As intensidades foram ajustadas a cada 5 minutos e mantidas abaixo do limiar motor. O balanço autonômico foi avaliado antes e após as intervenções pela variabilidade da frequência cardíaca (VFC). TENS a 10 Hz aumentou 10% da atividade simpática e diminui 10% a atividade parassimpática, mas a TENS a 100 Hz apresentou efeitos opostos (p < 0,05). O balanço simpato-vagal aumentou com a TENS de baixa frequência e diminuiu com a alta frequência (p < 0,05). Conclui-se que as diferentes frequências da TENS aplicadas sobre a trajetória do plexo nervoso braquial modificam as respostas autonômicas cardiovasculares. A alta frequência da TENS reduz a atividade simpática e aumenta a parassimpática, o que favorece aos efeitos benéficos sobre o balanço autonômico em voluntários saudáveis.Palavras-chave: estimulação elétrica, sistema nervoso autônomo, frequência cardíaca.

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Sympathetic activity–associated periodic repolarization dynamics predict mortality following myocardial infarction

Cited by 82 publications

References 54 publications

Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Periodic Repolarisation Dynamics: A Natural Probe of the Ventricular Response to Sympathetic Activation

Biosignal-guided personalized therapy

<b>Different frequencies of transcutaneous electrical nerve stimulation on sympatho-vagal balance

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