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Quantifying Acute Changes in Renal Sympathetic Nerve Activity in Response to Central Nervous System Manipulations in Anesthetized Rats
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High Skin Sympathetic Nerve Activity in Patients with Recurrent Syncope.

Tien-Chi Huang1, Nai-Yu Chi1, Chih-Sung Lan1

  • 1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.

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Summary

Skin sympathetic nerve activity (SKNA) is higher in individuals prone to vasovagal syncope (VVS). A new index combining SKNA and heart rate variability predicts syncope during head-up tilting tests.

Keywords:
head-up tilting testheart rate variabilityskin sympathetic nerve activityvasovagal syncope

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Area of Science:

  • Cardiology
  • Autonomic Neuroscience
  • Medical Diagnostics

Background:

  • Autonomic dysfunction is implicated in vasovagal syncope (VVS).
  • Head-up tilting test (HUT) is a standard diagnostic tool for VVS.
  • The novel neuECG method simultaneously records skin electrical signals and electrocardiograms.

Purpose of the Study:

  • To investigate the relationship between skin sympathetic nerve activity (SKNA) and HUT results.
  • To determine if elevated SKNA predicts positive HUT outcomes.
  • To evaluate the predictive value of a novel SKNA-SDNN index for syncope.

Main Methods:

  • 41 subjects underwent HUT using the "Italian protocol" with neuECG monitoring.
  • Analyzed average SKNA (aSKNA) and standard deviation of normal-to-normal intervals (SDNN) during HUT phases.
  • Calculated the "SKNA-SDNN index" using resting aSKNA and SDNN ratios.

Main Results:

  • 16 out of 41 subjects (39%) experienced syncope during HUT.
  • Tilt-positive subjects exhibited significantly higher resting aSKNA (1.21 ± 0.27 µV) compared to tilt-negative subjects (1.02 ± 0.29 µV).
  • Significant SKNA surges and withdrawals occurred 30 seconds before and after syncope events (p ≤ 0.006).
  • The SKNA-SDNN index demonstrated strong predictive capability for syncope (p < 0.001).

Conclusions:

  • Elevated resting SKNA is associated with positive HUT results, indicating a predisposition to VVS.
  • The SKNA-SDNN index serves as a novel and effective marker for predicting syncope during HUT.
  • This study highlights the utility of neuECG in assessing autonomic function related to VVS.