Skin sympathetic nerve activity and ventricular rate control during atrial fibrillation

Kusayama, Takashi; Douglas, Anthony; Jiang, Wan; Doytchinova, Anisiia; Wong, Johnson; Mitscher, Gloria A.; Straka, Susan; Shen, Changyu; Everett, Thomas H.; Chen, Peng Sheng

doi:10.1016/j.hrthm.2019.11.017

Cited by 19 publications

(8 citation statements)

References 27 publications

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“…[ 39 ]. Although some researchers regard 24-h SDNN as the “gold standard”, it is expensive, complex, time-consuming, and inconvenient for patients [ 12 , 41 ]. The method we utilized, 5-min SDNN, was therefore widely adopted in clinical studies [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

“…Skin sympathetic nerve activity (SKNA) analyzed by the neuECG recording is a novel method to harvest the electrical signal from the skin of subjects and can simultaneously record SKNA and electrocardiogram (ECG). neuECG is used as the sympathetic recording in several cardiac arrhythmic situations and might predict clinical outcome [12][13][14], so we intended to use SKNA as a novel biomarker to predict the outcome of our subject.…”

Section: Introductionmentioning

confidence: 99%

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Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

et al. 2022

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Background Chemoradiotherapy (CRT), which might affect the autonomic system, is the mainstay therapy for advanced esophageal squamous cell carcinoma (ESCC). Autonomic dysfunction has been found to possibly lead to cancer mortality in those with elevated resting heart rates (RHR). Skin sympathetic nerve activity (SKNA) is a new method of stimulating electrical signals in skin to evaluate autonomic function from sympathetic tone. In this study, we investigated the association between changes in RHR and autonomic function and ESCC mortality. Methods Thirty-nine stage II-IV ESCC patients receiving CRT between March 2019 and November 2020 were prospectively enrolled and carefully selected, followed up and received the same meticulous supportive care. Serial RHR was recorded every two weeks from before CRT to eight weeks after CRT and average SKNA were recorded before and four weeks after CRT. All-cause mortality was defined as primary outcome. Results We found the RHR of ESCC patients to be significantly elevated and peaking at four weeks after CRT (p < 0.001) and then to gradually decrease. Those with an elevated RHR above the cutoff level (18 beat-per-minute) at eight weeks after CRT had worse overall survival. In addition, those with higher baseline sympathetic tone (average SKNA ≥ 0.86 μV) also had poor outcome. Conclusions Increased pre-treatment sympathetic tone and elevated RHR after CRT are alarm signs of poor ESCC outcome. Further exploration of the mechanisms underlying these associations could potentially lead to intervention strategies for reducing mortality. Trial registration This study is registered with ClinicalTrials.gov, identifier: NCT03243448.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

et al. 2022

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“…Various methods of cardiac ANS assessment (heart rate variability, [ 82 , 83 ] skin sympathetic nerve activity [ 84 ], metaiodobenzylguanidine (MIBG) scintigraphy [ 85 ]) imply that ANS instability is implicated in human AF pathogenesis.…”

Section: Atrial Fibrillation Pathogenesismentioning

confidence: 99%

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

et al. 2021

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The prevalence of atrial fibrillation (AF) is bound to increase globally in the following years, affecting the quality of life of millions of people, increasing mortality and morbidity, and beleaguering health care systems. Increasingly effective therapeutic options against AF are the constantly evolving electroanatomic substrate mapping systems of the left atrium (LA) and ablation catheter technologies. Yet, a prerequisite for better long-term success rates is the understanding of AF pathogenesis and maintenance. LA electrical and anatomical remodeling remains in the epicenter of current research for novel diagnostic and treatment modalities. On a molecular level, electrical remodeling lies on impaired calcium handling, enhanced inwardly rectifying potassium currents, and gap junction perturbations. In addition, a wide array of profibrotic stimuli activates fibroblast to an increased extracellular matrix turnover via various intermediaries. Concomitant dysregulation of the autonomic nervous system and the humoral function of increased epicardial adipose tissue (EAT) are established mediators in the pathophysiology of AF. Local atrial lymphomononuclear cells infiltrate and increased inflammasome activity accelerate and perpetuate arrhythmia substrate. Finally, impaired intracellular protein metabolism, excessive oxidative stress, and mitochondrial dysfunction deplete atrial cardiomyocyte ATP and promote arrhythmogenesis. These overlapping cellular and molecular alterations hinder us from distinguishing the cause from the effect in AF pathogenesis. Yet, a plethora of therapeutic modalities target these molecular perturbations and hold promise in combating the AF burden. Namely, atrial selective ion channel inhibitors, AF gene therapy, anti-fibrotic agents, AF drug repurposing, immunomodulators, and indirect cardiac neuromodulation are discussed here.

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“…Skin sympathetic nerve activity (SKNA) is a recent and high-frequency method for the noninvasive detection of SNA, which is proved to be well correlated with stellate ganglion activity and valid in related studies of diseases with abnormal SNA ( Jiang et al, 2015 ; Doytchinova et al, 2017 ; He et al, 2020 ; Kusayama et al, 2020a ). The cardiac sympathetic nerve alternates at the stellate ganglion, and its postganglionic fibers control cardiac activity.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of autonomic nervous system activity in intradialytic hypotension using entropy and skin sympathetic nerve activity

Xing

Zhang

et al. 2023

Front. Neurosci.

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IntroductionThe function of the autonomic nervous system (ANS) is crucial in the development of intradialytic hypotension (IDH). This study introduced the entropy of heart rate variability (HRV) and skin sympathetic nerve activity (SKNA) to provide a complementary nonlinear and dynamic perspective for evaluating ANS function concerning IDH.Methods93 patients undergoing hemodialysis (HD) were enrolled, and the baseline data, electrocardiogram (ECG), and SKNA were collected. The patients were separated into the IDH and nonIDH groups based on the thresholds, which were characterized as reductions in systolic blood pressure (SBP) of at least 20 mm Hg or mean arterial pressure (MAP) of at least 10 mm Hg. We developed a logistic regression model for IDH after analyzing the changes in the time domain, frequency domain, the entropy of HRV, and SKNA indices during HD.ResultsAfter 4-h HD, the detected results for heart rate, the ratio of low frequency and high frequency (LF/HF), and average SKNA (aSKNA) all increased in both groups. Nine out of the ten HRV indices and aSKNA in the nonIDH group were higher than those in the IDH group at most moments. aSKNA was positively correlated with heart rate (p = 0.0001) and LF/HF (p = 0.0005) in the nonIDH group, while the correlation disappeared in the IDH group, which indicated a worse ANS response in IDH patients. The logistic regression model exhibited the results of initial SBP [odds ratio (OR) 1.076; p = 0.001], and the difference between the last and first segments (DLF) of heart rate [OR 1.101; p =0.012] and LF/HF [OR 0.209; p =0.034], as well as the extreme value of the difference between other segments and the first segments (EOF) of aSKNA [OR 2.908; p =0.017], which were independent indicators for IDH.DiscussionThe new nonlinear and dynamic assessment perspectives provided by the entropy of HRV and SKNA help to distinguish differences in ANS patterns between IDH patients and nonIDH patients and have the potential to be used in clinical monitoring for HD patients.

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Skin sympathetic nerve activity and ventricular rate control during atrial fibrillation

Cited by 19 publications

References 27 publications

Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

Molecular Insights in Atrial Fibrillation Pathogenesis and Therapeutics: A Narrative Review

Evaluation of autonomic nervous system activity in intradialytic hypotension using entropy and skin sympathetic nerve activity

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