Skin sympathetic nerve activity and the temporal clustering of cardiac arrhythmias
Takashi Kusayama, Juyi Wan, Anisiia Doytchinova, Johnson Wong, Ryan A. Kabir, Gloria Mitscher, Susan Straka, Changyu Shen, Thomas H. Everett IV, Peng-Sheng Chen
Takashi Kusayama, Juyi Wan, Anisiia Doytchinova, Johnson Wong, Ryan A. Kabir, Gloria Mitscher, Susan Straka, Changyu Shen, Thomas H. Everett IV, Peng-Sheng Chen
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Clinical Research and Public Health Cardiology

Skin sympathetic nerve activity and the temporal clustering of cardiac arrhythmias

Abstract

BACKGROUND. Simultaneous noninvasively recorded skin sympathetic nerve activity (SKNA) and electrocardiogram (neuECG) can be used to estimate cardiac sympathetic tone. We tested the hypothesis that large and prolonged SKNA bursts are associated with temporal clustering arrhythmias. METHODS. We recorded neuECG in 10 patients (69 ± 10 years old) with atrial fibrillation (AF) episodes and in 6 patients (50 ± 13 years old) with ventricular tachycardia (VT) or fibrillation (VF) episodes. Clustering was defined by an arrhythmic episode followed within 1 minute by spontaneous recurrences of the same arrhythmia. The neuECG signals were bandpass filtered between 500–1000 Hz to display SKNA. RESULTS. There were 22 AF clusters, including 231 AF episodes from 6 patients, and 9 VT/VF clusters, including 99 VT/VF episodes from 3 patients. A total duration of SKNA bursts associated with AF was longer than that during sinus rhythm (78.9 min/hour [interquartile range (IQR) 17.5–201.3] vs. 16.3 min/hour [IQR 14.5–18.5], P = 0.022). The burst amplitude associated with AF in clustering patients was significantly higher than that in nonclustering patients (1.54 μV [IQR 1.35–1.89], n = 114, vs. 1.20 μV [IQR 1.05–1.42], n = 21, P < 0.001). The SKNA bursts associated with VT/VF clusters lasted 9.3 ± 3.1 minutes, with peaks that averaged 1.13 ± 0.38 μV as compared with 0.79 ± 0.11 μV at baseline (P = 0.041). CONCLUSION. Large and sustained sympathetic nerve activities are associated with the temporal clustering of AF and VT/VF. FUNDING. This study was supported in part by NIH grants R42DA043391 (THE), R56 HL71140, TR002208-01, R01 HL139829 (PSC), a Charles Fisch Cardiovascular Research Award endowed by Suzanne B. Knoebel of the Krannert Institute of Cardiology (TK and THE), a Medtronic-Zipes Endowment, and the Indiana University Health-Indiana University School of Medicine Strategic Research Initiative (PSC).

Authors

Takashi Kusayama, Juyi Wan, Anisiia Doytchinova, Johnson Wong, Ryan A. Kabir, Gloria Mitscher, Susan Straka, Changyu Shen, Thomas H. Everett IV, Peng-Sheng Chen

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Figure 8

Clustering of VT episodes.

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Clustering of VT episodes. (A) The data came from same patient as shown ...
(A) The data came from same patient as shown in Figure 6B. Heart rate (black line) and average SKNA (aSKNA) from Lead I (blue) and Lead II (green) are plotted over time. A total of 8 VT episodes occurred during 1-hour periods of aSKNA. The onsets of VT are indicated by red dotted lines, with each red dotted line representing several individual episodes of VT, which could not be distinguished graphically. A red dot indicates the onset of aSKNA, which is associated with sinus HR acceleration before the development of VT. There is the latency between SKNA activation and the first VT onset (red bar) and deactivation to the last VT episode (blue bar). The large burst lasted 6 minutes (black bar). After VT clustering, smaller aSKNA bursts did not induce VT. (B) The data came from a different patient. A total of 11 VT episodes were observed during 2 hours of recording. Similar to A, large SKNA bursts preceded VT episodes, and the latency between SKNA onset and VT were 2 minutes and 7 minutes, respectively. There were smaller bursts of nerve activities associated with premature ventricular contributions (black arrows).