Skin Sympathetic Nerve Activity as a Biomarker for Syncopal Episodes during a Tilt Table Test
dc.contributor.author | Kumar, Awaneesh | |
dc.contributor.author | Wright, Keith | |
dc.contributor.author | Uceda, Domingo E. | |
dc.contributor.author | Vasallo, Peter A., III. | |
dc.contributor.author | Rabin, Perry L. | |
dc.contributor.author | Adams, David | |
dc.contributor.author | Wong, Johnson | |
dc.contributor.author | Das, Mithilesh | |
dc.contributor.author | Lin, Shien-Fong | |
dc.contributor.author | Chen, Peng-Sheng | |
dc.contributor.author | Everett, Thomas H., IV. | |
dc.contributor.department | Medicine, School of Medicine | en_US |
dc.date.accessioned | 2022-09-27T16:58:05Z | |
dc.date.available | 2022-09-27T16:58:05Z | |
dc.date.issued | 2020-05 | |
dc.description.abstract | Background: 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.version | Author's manuscript | en_US |
dc.identifier.citation | Kumar 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.2019.10.008 | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/30141 | |
dc.language.iso | en_US | en_US |
dc.publisher | Elsevier | en_US |
dc.relation.isversionof | 10.1016/j.hrthm.2019.10.008 | en_US |
dc.relation.journal | Heart Rhythm | en_US |
dc.rights | Publisher Policy | en_US |
dc.source | PMC | en_US |
dc.subject | Heart rate variability | en_US |
dc.subject | Nitroglycerine | en_US |
dc.subject | Skin sympathetic nerve activity | en_US |
dc.subject | Syncope | en_US |
dc.subject | Tilt table test | en_US |
dc.title | Skin Sympathetic Nerve Activity as a Biomarker for Syncopal Episodes during a Tilt Table Test | en_US |
dc.type | Article | en_US |