Skin sympathetic nerve activity as a biomarker for neurologic recovery during therapeutic hypothermia for cardiac arrest

Kutkut, Issa; Uceda, Domingo E.; Kumar, Amarendra; Wong, Johnson; Li, Xiaochun; Wright, Keith; Straka, Susan; Adams, David; Deckard, Michelle; Kovacs, Richard J.; Chen, Peng‐Sheng; Everett, Thomas H.

doi:10.1016/j.hrthm.2021.03.011

Cited by 6 publications

(9 citation statements)

References 27 publications

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“…Furthermore, we found a loss of HR-aSKNA correlation in the high IDWG subgroup. Low SKNA or a low correlation between SKNA and heart rate was previously associated with worse neurologic recovery outcomes in cardiac arrest patients undergoing targeted temperature management ( Kutkut et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, skin sympathetic nerve activity (SKNA) has become a novel noninvasive parameter to reflect real-time cardiac sympathetic nerve activity ( Doytchinova et al, 2017 ; Kusayama et al, 2020 ). This parameter has been widely used in cardiac arrhythmogenesis, acute myocardial infarction, sleep apnea, and neurologic recovery patients as a predictor of sympathetic tone ( Kusayama et al, 2019 ; He et al, 2020 ; Chen et al, 2021 ; Kutkut et al, 2021 ; Liu et al, 2021 ). However, in HD patients, the implications of SKNA have not been well elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Dynamics of Cardiac Autonomic Responses During Hemodialysis Measured by Heart Rate Variability and Skin Sympathetic Nerve Activity: The Impact of Interdialytic Weight Gain

et al. 2022

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Background: Autonomic nervous regulation plays a critical role in end-stage kidney disease (ESKD) patients with cardiovascular complications. However, studies on autonomic regulation in ESKD patients are limited to heart rate variability (HRV) analysis. Skin sympathetic nerve activity (SKNA), which noninvasively reflects the sympathetic nerve activity, has not been used in ESKD patients.Methods: Seventy-six patients on maintenance hemodialysis (MHD) treatment (a 4-h HD session, three times a week) were enrolled. Utilizing a noninvasive, single-lead, high-frequency recording system, we analyzed the dynamic change in HRV parameters and SKNA during HD. The different characteristics between the subgroups divided based on interdialytic weight gain (IDWG, <3 kg or ≥3 kg) were also demonstrated.Results: After the HD, values for heart rate (75.1 ± 11.3 to 80.3 ± 12.3 bpm, p < 0.001) and LF/HF (1.92 ± 1.67 to 2.18 ± 2.17, p = 0.013) were significantly higher than baseline. In subgroup analysis, average voltage of skin sympathetic nerve activity (aSKNA) in IDWG ≥3 kg group was lower than the IDWG <3 kg group at the end of MHD (1.06 ± 0.30 vs 1.32 ± 0.61 μV, p = 0.046). Moreover, there was a linear correlation between mean heart rate (HR) and aSKNA in low IDWG patients (p < 0.001), which was not found in high IDWG patients. At the 1-year follow-up, high IDWG patients had a higher incidence of cardiovascular hospitalization (p = 0.046).Conclusions: In MHD patients, a gradual activation of sympathetic nerve activity could be measured by HRV and aSKNA. A lower aSKNA at the end of HD and a loss of HR-aSKNA correlation in overhydrated patients were observed. Extensive volume control is promising to improve the autonomic nervous function and clinical outcomes in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dynamics of Cardiac Autonomic Responses During Hemodialysis Measured by Heart Rate Variability and Skin Sympathetic Nerve Activity: The Impact of Interdialytic Weight Gain

et al. 2022

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“…In addition to predicting AF recurrence, there are new applications in neuECG, such as acting as markers of orthostatic hypotension and recurrent syncope ( 30 , 31 ), predicting the occurrence of ventricular arrhythmia in acute coronary syndrome ( 32 ), and correlating with intradialytic weight gain in patients with end-stage renal disease ( 33 ). It has also been proposed as a marker of fitness ( 34 ) and to predict neurological recovery of patients who had cardiac arrest and are undergoing therapeutic hypothermia ( 35 ). An ambulatory electrogram monitor was developed to record the SKNA ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Alterations of sympathetic dynamics after atrial fibrillation ablation by analysis sympathetic nerve activity provide prognostic value for recurrence and mechanistic insights into ablation

Chen

Lin

Chuang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. Success is associated with autonomic function modulation; however, the relationship between the changes after ablation is not fully understood. We aimed to investigate the effect of ablation on autonomic modulation by skin sympathetic nerve activity (SKNA) using conventional electrocardiogram (ECG) electrodes and to predict the treatment success.MethodsWe enrolled 79 patients. We recorded neuECG for 10 min at 10 kHz before and after ablation. The NeuECG was bandpass-filtered (500–1,000 Hz) and integrated at intervals of 100 ms (iSKNA). iSKNA was averaged over different time windows (1-, 5-,10-s; aSKNAs), and burst analyses were derived from aSKNAs to quantify the dynamics of sympathetic activities. AF recurrence after 3 months was defined as the study endpoint.ResultsSixteen patients experienced AF recurrence after the ablation. For burst analysis of 1-s aSKNA, the recurrence group had a higher bursting frequency than the non-recurrence group (0.074 ± 0.055 vs. 0.109 ± 0.067; p < 0.05) before ablation. The differences between pre- and post-ablation of firing duration longer than 2 s were more in the non-recurrence group (2.75 ± 6.41 vs. −1.41 ± 5.14; p < 0.05), while no significant changes were observed in the percentage of duration longer than 10 s using 5-s aSKNA. In addition, decreases in differences in firing frequency and percentage of both overall firing duration and longer firing duration (> 2 s) between pre- and post-ablation were independently associated with AF recurrence and more area under receiver operating characteristics (ROC) curve in combination with CHADS2 score (0.833).ConclusionWe demonstrated the applicability of neuECG for determining sympathetic modulation during AF ablation. Decreasing sympathetic activity is the key to successful ablation.

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“…However, HRV from UST data could not fully show the nerve activity. The newly proposed noninvasive cardiac SNA assessment method (SKNA) and its derived metrices has been widely used in clinical events, such as acute myocardial infarction (He et al, 2020), neurologic recovery patients (Liu et al, 2021a), and sleep apnea (Kutkut et al, 2021). Nevertheless, these SKNAderived metrics could only qualitatively analyze ANS and could not quantitatively reflect ANS intensity or ANS-Load.…”

Section: Figurementioning

confidence: 99%

“…As a non-invasive and versatile SNA assessment method, skin sympathetic nerve activity (SKNA) has been applied to many clinical events (Doytchinova et al, 2017;Kusayama et al, 2020) and been proven to have the potential to predict sympathetic tone in many applications (i.e., acute myocardial infarction (He et al, 2020), neurologic recovery patients (Liu et al, 2021a), and sleep apnea (Kutkut et al, 2021)). To this juncture, several parameters have been derived from SKNA to quantify SNA.…”

Section: Introductionmentioning

confidence: 99%

Autonomic nervous activity analysis based on visibility graph complex networks and skin sympathetic nerve activity

Cai

Cheng²,

Xing³

et al. 2022

Front. Physiol.

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Background: Autonomic nerve system (ANS) plays an important role in regulating cardiovascular function and cerebrovascular function. Traditional heart rate variation (HRV) and emerging skin sympathetic nerve activity (SKNA) analyses from ultra-short-time (UST) data cannot fully reveal neural activity, thereby quantitatively reflect ANS intensity.Methods: Electrocardiogram and SKNA from sixteen patients (seven cerebral hemorrhage (CH) patients and nine control group (CO) patients) were recorded using a portable device. Ten derived HRV (mean, standard deviation and root mean square difference of sinus RR intervals (NNmean, SDNN and RMSSD), ultra-low frequency (<0.003 Hz, uLF), very low frequency ([0.003 Hz, 0.04 Hz), vLF), low frequency ([0.04 Hz, 0.15 Hz), LF) and high frequency power ([0.15 Hz, 0.4 Hz), HF), ratio of LF to HF (LF/HF), the standard deviation of instantaneous beat-to-beat R-R interval variability (SD1), and approximate entropy (ApEn)) and ten visibility graph (VG) features (diameter (Dia), average node degree (aND), average shortest-path length (aSPL), clustering coefficient (CC), average closeness centrality (aCC), transitivity (Trans), average degree centrality (aDC), link density (LD), sMetric (sM) and graph energy (GE) of the constructed complex network) were compared on 5-min and UST segments to verify their validity and robustness in discriminating CH and CO under different data lengths. Besides, their potential for quantifying ANS-Load were also investigated.Results: The validation results of HRV and VG features in discriminating CH from CO showed that VG features were more clearly distinguishable between the two groups than HRV features. For effectiveness evaluation of analyzing ANS on UST segment, the NNmean, SDNN, RMSSD, LF, HF and LF/HF in HRV features and the CC, Trans, Dia and GE of VG features remained stable in both activated and inactivated segments across all data lengths. The capability of HRV and VG features in quantifying ANS-Load were evaluated and compared under different ANS-Load, the results showed that most HRV features (SDNN, LFHF, RMSSD, vLF, LF and HF) and almost all VG features were correlated to sympathetic nerve activity intensity.Conclusions: The proposed autonomic nervous activity analysis method based on VG and SKNA offers a new insight into ANS assessment in UST segments and ANS-Load quantification.

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Skin sympathetic nerve activity as a biomarker for neurologic recovery during therapeutic hypothermia for cardiac arrest

Cited by 6 publications

References 27 publications

Dynamics of Cardiac Autonomic Responses During Hemodialysis Measured by Heart Rate Variability and Skin Sympathetic Nerve Activity: The Impact of Interdialytic Weight Gain

Dynamics of Cardiac Autonomic Responses During Hemodialysis Measured by Heart Rate Variability and Skin Sympathetic Nerve Activity: The Impact of Interdialytic Weight Gain

Alterations of sympathetic dynamics after atrial fibrillation ablation by analysis sympathetic nerve activity provide prognostic value for recurrence and mechanistic insights into ablation

Autonomic nervous activity analysis based on visibility graph complex networks and skin sympathetic nerve activity

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