Simultaneous noninvasive recording of skin sympathetic nerve activity and electrocardiogram.
Sympathetic nerve activity is important to cardiac arrhythmogenesis.



The purpose of this study was to develop a method for simultaneous noninvasive recording of skin sympathetic nerve activity (SKNA) and electrocardiogram (ECG) using conventional ECG electrodes. This method (neuECG) can be used to adequately estimate sympathetic tone.



We recorded neuECG signals from the skin of 56 human subjects. The signals were low-pass filtered to show the ECG and high-pass filtered to show nerve activity. Protocol 1 included 12 healthy volunteers who underwent cold water pressor test and Valsalva maneuver. Protocol 2 included 19 inpatients with epilepsy but without known heart diseases monitored for 24 hours. Protocol 3 included 22 patients admitted with electrical storm and monitored for 39.0 ± 28.2 hours. Protocol 4 included 3 patients who underwent bilateral stellate ganglion blockade with lidocaine injection.



In patients without heart diseases, spontaneous nerve discharges were frequently observed at baseline and were associated with heart rate acceleration. SKNA recorded from chest leads (V1-V6) during cold water pressor test and Valsalva maneuver (protocol 1) was invariably higher than during baseline and recovery periods (P < .001). In protocol 2, the average SKNA correlated with heart rate acceleration (r = 0.73 ± 0.14, P < .05) and shortening of QT interval (P < .001). Among 146 spontaneous ventricular tachycardia episodes recorded in 9 patients of protocol 3, 106 episodes (73%) were preceded by SKNA within 30 seconds of onset. Protocol 4 showed that bilateral stellate ganglia blockade by lidocaine inhibited SKNA.



SKNA is detectable using conventional ECG electrodes in humans and may be useful in estimating sympathetic tone.
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Anisiia
A
Doytchinova
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Jonathan L
JL
Hassel
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Yuan
Y
Yuan
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
Hongbo
H
Lin
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
Dechun
D
Yin
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
David
D
Adams
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Susan
S
Straka
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Keith
K
Wright
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Kimberly
K
Smith
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
David
D
Wagner
Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana.
Changyu
C
Shen
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
Vicenta
V
Salanova
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
Chad
C
Meshberger
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
Lan S
LS
Chen
Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana.
John C
JC
Kincaid
Division of Cardiothoracic Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
Arthur C
AC
Coffey
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Gang
G
Wu
Department of Geriatrics, Shengjing Hospital, China Medical University, Shenyang, China.
Yan
Y
Li
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Richard J
RJ
Kovacs
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Thomas H
TH
Everett
Cedars-Sinai Heart Institute/Hypertension Center(,) Los Angeles, California.
Ronald
R
Victor
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
Yong-Mei
YM
Cha
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Institute of Biomedical Engineering, National Chiao-Tung University, Hsin-Chu, Taiwan.
Shien-Fong
SF
Lin
Krannert Institute of Cardiology and Division of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address: chenpp@iu.edu.
Peng-Sheng
PS
Chen
D000368:Aged; D016022:Case-Control Studies; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012867:Skin / Q000294:innervation*; D013233:Stellate Ganglion / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000175:diagnosis*
Cold water pressor test; Microneurography; Sympathetic nerve activity; Ventricular tachycardia
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