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

A Uradu, J Wan, A Doytchinova, KC Wright, AYT Lin… - Heart rhythm, 2017 - Elsevier
A Uradu, J Wan, A Doytchinova, KC Wright, AYT Lin, LS Chen, C Shen, SF Lin, TH Everett IV
Heart rhythm, 2017Elsevier
Background Skin sympathetic nerve activity (SKNA) is useful for estimating sympathetic tone
in humans. Objective The purpose of this study was to test the hypotheses that (1) increased
SKNA is associated with the onset and termination of paroxysmal atrial tachycardia (AT) and
atrial fibrillation (AF) and (2) sinoatrial node response to SKNA is reduced in patients with
more frequent AT or AF episodes. Methods SKNA and electrocardiogram were recorded in
11 patients (4 men and 7 women; average age 66±10 years), including 3 patients with AT …
Background
Skin sympathetic nerve activity (SKNA) is useful for estimating sympathetic tone in humans.
Objective
The purpose of this study was to test the hypotheses that (1) increased SKNA is associated with the onset and termination of paroxysmal atrial tachycardia (AT) and atrial fibrillation (AF) and (2) sinoatrial node response to SKNA is reduced in patients with more frequent AT or AF episodes.
Methods
SKNA and electrocardiogram were recorded in 11 patients (4 men and 7 women; average age 66 ± 10 years), including 3 patients with AT (11 ± 18 episodes per patient) and 8 patients with AF (24 ± 26 episodes per patient).
Results
The average SKNA (aSKNA) 10 seconds before AT onset was 1.07 ± 0.10 μV and 10 seconds after termination was 1.27 ± 0.10 μV; both were significantly (P = .032 and P < .0001) higher than that during sinus rhythm (0.97 ± 0.09 μV). The aSKNA 10 seconds before AF onset was 1.34 ± 0.07 μV and 10 seconds after termination was 1.31 ± 0.07 μV; both were significantly (P < .0001) higher than that during sinus rhythm (1.04 ± 0.07 μV). The aSKNA before onset (P < .0001) and after termination (P = .0011) was higher in AF than in AT. The sinus rate correlated (P < .0001) with aSKNA in each patient (average r = 0.74; 95% confidence interval 0.65–0.84). The r value in each patient negatively correlated with the number of AT and AF episodes (r = −0.6493; 95% confidence interval −0.8990 to −0.08073; P = .0306).
Conclusion
Increased SKNA was observed both at the onset and termination of AT and AF. Patients with more frequent AT and AF episodes had a weak correlation between sinus rate and aSKNA, suggesting sinoatrial node remodeling by tachycardia.
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