Skin Sympathetic Nerve Activity as a Biomarker for Syncopal Episodes during a Tilt Table Test

dc.contributor.authorKumar, Awaneesh
dc.contributor.authorWright, Keith
dc.contributor.authorUceda, Domingo E.
dc.contributor.authorVasallo, Peter A., III.
dc.contributor.authorRabin, Perry L.
dc.contributor.authorAdams, David
dc.contributor.authorWong, Johnson
dc.contributor.authorDas, Mithilesh
dc.contributor.authorLin, Shien-Fong
dc.contributor.authorChen, Peng-Sheng
dc.contributor.authorEverett, Thomas H., IV.
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2022-09-27T16:58:05Z
dc.date.available2022-09-27T16:58:05Z
dc.date.issued2020-05
dc.description.abstractBackground: Autonomic imbalance is the proposed mechanism of syncope during a tilt table test (TTT). We have recently demonstrated that skin sympathetic nerve activity (SKNA) can be noninvasively recorded using electrocardiographic electrodes. Objective: The purpose of this study was to test the hypothesis that increased SKNA activation precedes tilt-induced syncope. Methods: We studied 50 patients with a history of neurocardiogenic syncope undergoing a TTT. The recorded signals were band-pass filtered at 500-1000 Hz to analyze nerve activity. Results: The average SKNA (aSKNA) value at baseline was 1.38 ± 0.38 μV in patients without syncope and 1.42 ± 0.52 μV in patients with syncope (P = .77). On upright tilt, aSKNA was 1.34 ± 0.40 μV in patients who did not have syncope and 1.39 ± 0.43 μV in patients who had syncope (P = .65). In all 14 patients with syncope, there was a surge of SKNA before an initial increase in heart rate followed by bradycardia, hypotension, and syncope. The peak aSKNA immediately (<1 minute) before syncope was significantly higher than baseline aSKNA (2.63 ± 1.22 vs 1.39 ± 0.43 μV; P = .0005). After syncope, patients were immediately placed in the supine position and aSKNA dropped significantly to 1.26 ± 0.43 μV; (P = .0004). The heart rate variability during the TTT shows a significant increase in parasympathetic tone during syncope (low-frequency/high-frequency ratio: 7.15 vs 2.21; P = .04). Conclusion: Patients with syncope do not have elevated sympathetic tone at baseline or during the TTT except immediately before syncope when there is a transient surge of SKNA followed by sympathetic withdrawal along with parasympathetic surge.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationKumar A, Wright K, Uceda DE, et al. Skin sympathetic nerve activity as a biomarker for syncopal episodes during a tilt table test. Heart Rhythm. 2020;17(5 Pt A):804-812. doi:10.1016/j.hrthm.2019.10.008en_US
dc.identifier.urihttps://hdl.handle.net/1805/30141
dc.language.isoen_USen_US
dc.publisherElsevieren_US
dc.relation.isversionof10.1016/j.hrthm.2019.10.008en_US
dc.relation.journalHeart Rhythmen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectHeart rate variabilityen_US
dc.subjectNitroglycerineen_US
dc.subjectSkin sympathetic nerve activityen_US
dc.subjectSyncopeen_US
dc.subjectTilt table testen_US
dc.titleSkin Sympathetic Nerve Activity as a Biomarker for Syncopal Episodes during a Tilt Table Testen_US
dc.typeArticleen_US
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