Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure
Aims: Microvolt T-wave alternans (TWA), an oscillation in T-wave morphology of the electrocardiogram (ECG), has been associated with increased susceptibility to ventricular tachy-arrhythmias, while vagus nerve stimulation has shown promising anti-arrhythmic effects in in vivo and ex vivo animal stud...
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doaj-1c25444179d24ed596a74a1dfeeaf1d22021-07-23T12:11:13ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2021-07-011210.3389/fphys.2021.707724707724Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart FailureKanchan Kulkarni0Stavros Stavrakis1Khaled Elkholey2Jagmeet P. Singh3Kimberly A. Parks4Antonis A. Armoundas5Antonis A. Armoundas6Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United StatesHeart Rhythm Institute, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United StatesHeart Rhythm Institute, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, United StatesCardiology Division, Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, United StatesCardiology Division, Brigham and Women’s Hospital, Boston, MA, United StatesCardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United StatesInstitute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United StatesAims: Microvolt T-wave alternans (TWA), an oscillation in T-wave morphology of the electrocardiogram (ECG), has been associated with increased susceptibility to ventricular tachy-arrhythmias, while vagus nerve stimulation has shown promising anti-arrhythmic effects in in vivo and ex vivo animal studies. We aimed to examine the effect of non-invasive, acute low-level tragus stimulation (LLTS) on TWA in patients with ischemic cardiomyopathy and heart failure.Methods: 26 patients with ischemic cardiomyopathy (left ventricular ejection fraction <35%) and chronic stable heart failure, previously implanted with an automatic implantable cardioverter defibrillator (ICD) device with an atrial lead (dual chamber ICD or cardiac resynchronization therapy defibrillator), were enrolled in the study. Each patient sequentially received, (1) Sham LLTS (electrode on tragus, but no stimulation delivered) for 5 min; (2) Active LLTS at two different frequencies (5 and 20 Hz, 15 min each); and (3) Active LLTS, during concomitant atrial pacing at 100 bpm at two different frequencies (5 and 20 Hz, 15 min each). LLTS was delivered through a transcutaneous electrical nerve stimulation device (pulse width 200 μs, frequency 5/20 Hz, amplitude 1 mA lower than the discomfort threshold). TWA burden was assessed using continuous ECG monitoring during sham and active LLTS in sinus rhythm, as well as during atrial pacing.Results: Right atrial pacing at 100 bpm led to significantly heightened TWA burden compared to sinus rhythm, with or without LLTS. Acute LLTS at both 5 and 20 Hz, during sinus rhythm led to a significant rise in TWA burden in the precordial leads (p < 0.05).Conclusion: Acute LLTS results in a heart-rate dependent increase in TWA burden.https://www.frontiersin.org/articles/10.3389/fphys.2021.707724/fullheart failureventricular arrhythmiasvagal stimulationT-wave alternansspectral method |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kanchan Kulkarni Stavros Stavrakis Khaled Elkholey Jagmeet P. Singh Kimberly A. Parks Antonis A. Armoundas Antonis A. Armoundas |
spellingShingle |
Kanchan Kulkarni Stavros Stavrakis Khaled Elkholey Jagmeet P. Singh Kimberly A. Parks Antonis A. Armoundas Antonis A. Armoundas Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure Frontiers in Physiology heart failure ventricular arrhythmias vagal stimulation T-wave alternans spectral method |
author_facet |
Kanchan Kulkarni Stavros Stavrakis Khaled Elkholey Jagmeet P. Singh Kimberly A. Parks Antonis A. Armoundas Antonis A. Armoundas |
author_sort |
Kanchan Kulkarni |
title |
Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure |
title_short |
Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure |
title_full |
Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure |
title_fullStr |
Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure |
title_full_unstemmed |
Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure |
title_sort |
microvolt t-wave alternans is modulated by acute low-level tragus stimulation in patients with ischemic cardiomyopathy and heart failure |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Physiology |
issn |
1664-042X |
publishDate |
2021-07-01 |
description |
Aims: Microvolt T-wave alternans (TWA), an oscillation in T-wave morphology of the electrocardiogram (ECG), has been associated with increased susceptibility to ventricular tachy-arrhythmias, while vagus nerve stimulation has shown promising anti-arrhythmic effects in in vivo and ex vivo animal studies. We aimed to examine the effect of non-invasive, acute low-level tragus stimulation (LLTS) on TWA in patients with ischemic cardiomyopathy and heart failure.Methods: 26 patients with ischemic cardiomyopathy (left ventricular ejection fraction <35%) and chronic stable heart failure, previously implanted with an automatic implantable cardioverter defibrillator (ICD) device with an atrial lead (dual chamber ICD or cardiac resynchronization therapy defibrillator), were enrolled in the study. Each patient sequentially received, (1) Sham LLTS (electrode on tragus, but no stimulation delivered) for 5 min; (2) Active LLTS at two different frequencies (5 and 20 Hz, 15 min each); and (3) Active LLTS, during concomitant atrial pacing at 100 bpm at two different frequencies (5 and 20 Hz, 15 min each). LLTS was delivered through a transcutaneous electrical nerve stimulation device (pulse width 200 μs, frequency 5/20 Hz, amplitude 1 mA lower than the discomfort threshold). TWA burden was assessed using continuous ECG monitoring during sham and active LLTS in sinus rhythm, as well as during atrial pacing.Results: Right atrial pacing at 100 bpm led to significantly heightened TWA burden compared to sinus rhythm, with or without LLTS. Acute LLTS at both 5 and 20 Hz, during sinus rhythm led to a significant rise in TWA burden in the precordial leads (p < 0.05).Conclusion: Acute LLTS results in a heart-rate dependent increase in TWA burden. |
topic |
heart failure ventricular arrhythmias vagal stimulation T-wave alternans spectral method |
url |
https://www.frontiersin.org/articles/10.3389/fphys.2021.707724/full |
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