Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation
Background Low‐level tragus stimulation (LLTS) has been shown to significantly reduce atrial fibrillation (AF) burden in patients with paroxysmal AF. P‐wave alternans (PWA) is believed to be generated by the same substrate responsible for AF. Hence, PWA may serve as a marker in guiding LLTS therapy....
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020865 |
| _version_ | 1818312292289216512 |
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| author | Kanchan Kulkarni Jagmeet P. Singh Kimberly A. Parks Demosthenes G. Katritsis Stavros Stavrakis Antonis A. Armoundas |
| author_facet | Kanchan Kulkarni Jagmeet P. Singh Kimberly A. Parks Demosthenes G. Katritsis Stavros Stavrakis Antonis A. Armoundas |
| author_sort | Kanchan Kulkarni |
| collection | DOAJ |
| description | Background Low‐level tragus stimulation (LLTS) has been shown to significantly reduce atrial fibrillation (AF) burden in patients with paroxysmal AF. P‐wave alternans (PWA) is believed to be generated by the same substrate responsible for AF. Hence, PWA may serve as a marker in guiding LLTS therapy. We investigated the utility of PWA in guiding LLTS therapy in patients with AF. Methods and Results Twenty‐eight patients with AF were randomized to either active LLTS or sham (earlobe stimulation). LLTS was delivered through a transcutaneous electrical nerve stimulation device (pulse width 200 μs, frequency 20 Hz, amplitude 10–50 mA), for 1 hour daily over a 6‐month period. AF burden over 2‐week periods was assessed by noninvasive continuous ECG monitoring at baseline, 3 months, and 6 months. A 5‐minute control ECG for PWA analysis was recorded during all 3 follow‐up visits. Following the control ECG, an additional 5‐minute ECG was recorded during active LLTS in all patients. At baseline, acute LLTS led to a significant rise in PWA burden. However, active patients receiving chronic LLTS demonstrated a significant reduction in both PWA and AF burden after 6 months (P<0.05). Active patients who demonstrated an increase in PWA burden with acute LLTS showed a significant drop in AF burden after 6 months of chronic LLTS. Conclusions Chronic, intermittent LLTS resulted in lower PWA and AF burden than did sham control stimulation. Our results support the use of PWA as a potential marker for guiding LLTS treatment of paroxysmal AF. |
| first_indexed | 2024-12-13T08:15:32Z |
| format | Article |
| id | doaj.art-d18f414019cd43f9814f2cdbb93c2100 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:15:32Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d18f414019cd43f9814f2cdbb93c21002022-12-21T23:54:08ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101210.1161/JAHA.120.020865Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial FibrillationKanchan Kulkarni0Jagmeet P. Singh1Kimberly A. Parks2Demosthenes G. Katritsis3Stavros Stavrakis4Antonis A. Armoundas5Cardiovascular Research Center Massachusetts General Hospital Boston MACardiology Division Cardiac Arrhythmia Service Massachusetts General Hospital Boston MACardiology Division Brigham and Womens Hospital Boston MAHygeia Hospital Athens GreeceHeart Rhythm Institute University of Oklahoma Health Sciences Center Oklahoma City OKCardiovascular Research Center Massachusetts General Hospital Boston MABackground Low‐level tragus stimulation (LLTS) has been shown to significantly reduce atrial fibrillation (AF) burden in patients with paroxysmal AF. P‐wave alternans (PWA) is believed to be generated by the same substrate responsible for AF. Hence, PWA may serve as a marker in guiding LLTS therapy. We investigated the utility of PWA in guiding LLTS therapy in patients with AF. Methods and Results Twenty‐eight patients with AF were randomized to either active LLTS or sham (earlobe stimulation). LLTS was delivered through a transcutaneous electrical nerve stimulation device (pulse width 200 μs, frequency 20 Hz, amplitude 10–50 mA), for 1 hour daily over a 6‐month period. AF burden over 2‐week periods was assessed by noninvasive continuous ECG monitoring at baseline, 3 months, and 6 months. A 5‐minute control ECG for PWA analysis was recorded during all 3 follow‐up visits. Following the control ECG, an additional 5‐minute ECG was recorded during active LLTS in all patients. At baseline, acute LLTS led to a significant rise in PWA burden. However, active patients receiving chronic LLTS demonstrated a significant reduction in both PWA and AF burden after 6 months (P<0.05). Active patients who demonstrated an increase in PWA burden with acute LLTS showed a significant drop in AF burden after 6 months of chronic LLTS. Conclusions Chronic, intermittent LLTS resulted in lower PWA and AF burden than did sham control stimulation. Our results support the use of PWA as a potential marker for guiding LLTS treatment of paroxysmal AF.https://www.ahajournals.org/doi/10.1161/JAHA.120.020865atrial fibrillationP‐wave alternansspectral methodvagal stimulation |
| spellingShingle | Kanchan Kulkarni Jagmeet P. Singh Kimberly A. Parks Demosthenes G. Katritsis Stavros Stavrakis Antonis A. Armoundas Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease atrial fibrillation P‐wave alternans spectral method vagal stimulation |
| title | Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation |
| title_full | Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation |
| title_fullStr | Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation |
| title_full_unstemmed | Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation |
| title_short | Low‐Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation |
| title_sort | low level tragus stimulation modulates atrial alternans and fibrillation burden in patients with paroxysmal atrial fibrillation |
| topic | atrial fibrillation P‐wave alternans spectral method vagal stimulation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020865 |
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