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

Heart Rhythm. 2017 Jul;14(7):964-971. doi: 10.1016/j.hrthm.2017.03.030. Epub 2017 Mar 24.

Abstract

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.

Keywords: Arrhythmia; Autonomic nervous system; Sick sinus syndrome; neuECG.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / etiology
  • Atrial Fibrillation / physiopathology*
  • Diagnostic Techniques, Neurological
  • Electrocardiography / methods
  • Female
  • Heart Rate / physiology*
  • Humans
  • Male
  • Middle Aged
  • Sinoatrial Node* / physiology
  • Sinoatrial Node* / physiopathology
  • Skin / innervation*
  • Statistics as Topic
  • Sympathetic Nervous System* / physiology
  • Sympathetic Nervous System* / physiopathology
  • Tachycardia, Supraventricular / diagnosis
  • Tachycardia, Supraventricular / etiology
  • Tachycardia, Supraventricular / physiopathology*