Sympathetic toggled paroxysmal atrial fibrillation and recurrent premature atrial contractions in ambulatory patients

Daerin Hwang; Xiao Liu; Anxhela Kote; Jewel Reaso; Taiga Andersson; Michael M Shehata; Ashkan Ehdaie; Xunzhang Wang; Eugenio Cingolani; Archana Ramireddy; Eric D Braunstein; Lan S Chen; Xiaochun Li; Joshua Goldhaber; Peng-Sheng Chen

doi:10.1016/j.hrthm.2024.05.029

Sympathetic toggled paroxysmal atrial fibrillation and recurrent premature atrial contractions in ambulatory patients

Heart Rhythm. 2024 May 16:S1547-5271(24)02571-2. doi: 10.1016/j.hrthm.2024.05.029. Online ahead of print.

Authors

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
² Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, IN.
³ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California 90095.
⁴ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048. Electronic address: chenp@cshs.org.

PMID: 38762134
DOI: 10.1016/j.hrthm.2024.05.029

Abstract

Background: Autonomic nerve activity is important in the mechanisms of paroxysmal atrial fibrillation (PAF).

Objective: To test the hypothesis that a single burst of skin sympathetic nerve activity (SKNA) can toggle on and off PAF or premature atrial contraction (PAC) clusters.

Methods: We performed neuECG recording over 7 days in patients with PAF.

Results: In Study 1, we found 8 patients (7 men, 1 woman, 62±8 years) had 124 episodes of PAF. An SKNA burst toggled both on and off PAF in 8 (6.5%) episodes (Type 1), toggled on but not off in 12 (9.7%) episodes (Type 2), and toggled on a PAC cluster, followed by PAF in 4 (3.2%) episodes (Type 3). The duration of these PAF episodes was < 10 min. The remaining 100 (80.6%) episodes were associated with active SKNA bursts throughout PAF (Type 4) and lasted longer than Type 1 (p=0.0185) and Type 2 (p=0.0027) PAF. There were 47 PAC clusters. Among them, 24 (51.1%) were toggled on and off, and 23 (48.9%) were toggled on but not off by an SKNA burst. In Study 2, we found 17 patients (9 men, 8 women, 58±12 years) with < 10 min PAF (4, 8, 0, and 31 of Types 1-4, respectively). There were significant circadian variations of all types of PAF.

Conclusions: A single SKNA burst can toggle short-duration PAF and PAC cluster episodes on and off. The absence of continued SKNA after the onset might have affected the maintenance of these arrhythmias.

Keywords: Ambulatory monitoring; Autonomic nervous system; Premature atrial contractions; Pulmonary veins; Skin sympathetic nerve activity; Triggered activity.