Key result
Large and sustained skin sympathetic nerve activity bursts are associated with the temporal clustering of atrial fibrillation, with significantly higher burst amplitudes in clustering versus nonclustering patients (1.54 μV vs 1.20 μV, P < 0.001).
Why the study?
Simultaneous noninvasively recorded skin sympathetic nerve activity and ECG can estimate cardiac sympathetic tone, prompting evaluation of whether large and prolonged bursts are associated with temporal clustering arrhythmias.
Does increased skin sympathetic nerve activity (SKNA) associate with the temporal clustering of atrial fibrillation and ventricular tachyarrhythmias?
Observational (n=16)
No
Does increased skin sympathetic nerve activity (SKNA) associate with the temporal clustering of atrial fibrillation and ventricular tachyarrhythmias?
Absolute Event Rate: 1.54% vs 1.2%
p-value: p=<0.001
Large and sustained skin sympathetic nerve activity (SKNA) bursts are significantly associated with the temporal clustering of both atrial fibrillation and ventricular tachyarrhythmias.
SKNA bursts may flag AF clustering risk; hypothesis-generating for sympathetic modulation trials.
BACKGROUND: Simultaneous noninvasively recorded skin sympathetic nerve activity (SKNA) and electrocardiogram (neuECG) can be used to estimate cardiac sympathetic tone. We tested the hypothesis that large and prolonged SKNA bursts are associated with temporal clustering arrhythmias. METHODS: We recorded neuECG in 10 patients (69 ± 10 years old) with atrial fibrillation (AF) episodes and in 6 patients (50 ± 13 years old) with ventricular tachycardia (VT) or fibrillation (VF) episodes. Clustering was defined by an arrhythmic episode followed within 1 minute by spontaneous recurrences of the same arrhythmia. The neuECG signals were bandpass filtered between 500-1000 Hz to display SKNA. RESULTS: There were 22 AF clusters, including 231 AF episodes from 6 patients, and 9 VT/VF clusters, including 99 VT/VF episodes from 3 patients. A total duration of SKNA bursts associated with AF was longer than that during sinus rhythm (78.9 min/hour [interquartile range (IQR) 17.5-201.3] vs. 16.3 min/hour [IQR 14.5-18.5], P = 0.022). The burst amplitude associated with AF in clustering patients was significantly higher than that in nonclustering patients (1.54 μV [IQR 1.35-1.89], n = 114, vs. 1.20 μV [IQR 1.05-1.42], n = 21, P < 0.001). The SKNA bursts associated with VT/VF clusters lasted 9.3 ± 3.1 minutes, with peaks that averaged 1.13 ± 0.38 μV as compared with 0.79 ± 0.11 μV at baseline (P = 0.041). CONCLUSION: Large and sustained sympathetic nerve activities are associated with the temporal clustering of AF and VT/VF. FUNDING: This study was supported in part by NIH grants R42DA043391 (THE), R56 HL71140, TR002208-01, R01 HL139829 (PSC), a Charles Fisch Cardiovascular Research Award endowed by Suzanne B. Knoebel of the Krannert Institute of Cardiology (TK and THE), a Medtronic-Zipes Endowment, and the Indiana University Health-Indiana University School of Medicine Strategic Research Initiative (PSC).
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Kusayama et al. (2019) conducted an observational in Atrial fibrillation and ventricular tachycardia/fibrillation (n=16). Skin sympathetic nerve activity (SKNA) recording vs. Nonclustering patients or baseline sinus rhythm was evaluated on SKNA burst amplitude associated with AF in clustering vs nonclustering patients (p=<0.001). Large and sustained skin sympathetic nerve activity bursts are associated with the temporal clustering of atrial fibrillation, with significantly higher burst amplitudes in clustering versus nonclustering patients (1.54 μV vs 1.20 μV, P < 0.001).
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