Investigation of the effect of tens treatment on cardiac electrical activity using proarrhythmogenic markers

Abstract

Objective: It was aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) treatment, which is widely used for pain, on cardiac electrical activity by using new proarrhythmogenic markers that give an idea on cardiac arrhythmia. Material Method: Forty patients (21 females, 19 males, mean age 56.60 ± 10.38) who applied to our outpatient clinic with the complaint of pain in the left shoulder or limitation of motion were included in our study. A fifteen-session physical therapy program was applied to the patients. Twelve-lead electrocardiography (ECG) was performed before treatment, at the end of the first day of treatment, and after treatment; and heart rate, QT interval (cQT) corrected according to Bazett formula, Tp-e / QT and electrophysiological balance index (iCEB) ratio were measured. The relationship of the measurements before treatment-first day after treatment, before treatment-fifteenth day after treatment and first day after treatment-fifteenth day after treatment was evaluated by Paired-Samples T test analysis. Results: In our study, when heart rate, cQT, Tp-e / QT and iCEB values were statistically analyzed, no significant difference was observed between measurements, since p> 0.05. Conclusion: In our study, when the heart rate, new proarrhythmogenic markers cQT, Tp-e / QT and iCEB values were examined in patients who received physical therapy to the left shoulder region, it was seen that TENS treatment did not have a significant effect on cardiac rhythm.

Keywords

• TENS
• ECG
• rhythm
• cQT
• Tp-e / QT ratio and iCEB

References

1. DeSantana JM, Walsh DM, Vance C, Rakel BA, Sluka KA. Effectiveness of transcutaneous electrical nerve stimulation for treatment of hyperalgesia and pain. Curr Rheumatol Rep 2008; 10: 492.
2. Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965; 150: 971-9.
3. Chabal C, Fishbain DA, Weaver M, Heine LW. Long-term transcutaneous electrical nerve stimulation (TENS) use: impact on medication utilization and physical therapy costs. Clin J Pain 1998; 14: 66-73.
4. Khadilkar A, Odebiyi DO, Brosseau L, Wells GA. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. Cochrane Database Syst Rev 2008: 4.
5. Jones I, Johnson MI. Transcutaneous electrical nerve stimulation. Continuing Education in Anaesthesia, Crit Care Pain 2009; 9: 130-5.
6. Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am College Cardiol 2006; 47: 362-7.
7. Yontar OC, Karaagac K, Tenekecioglu E, Tutuncu A, Demir M, Melek M. Assessment of ventricular repolarization inhomogeneity in patients with mitral valve prolapse: value of T wave peak to end interval. Int J Clin Experimental Med 2014; 7: 2173.
8. Meier P, Gloekler S, de Marchi SF, Zbinden R, Delacrétaz E, Seiler C. An indicator of sudden cardiac death during brief coronary occlusion: electrocardiogram QT time and the role of collaterals. Eur Heart J 2010; 31: 1197-204.

9. Hetland M, Haugaa KH, Sarvari SI, Erikssen G, Kongsgaard E, Edvardsen T. A novel ECG index for prediction of ventricular arrhythmias in patients after myocardial infarction. Ann Noninvasive Electrocardiol 2014; 19: 330-7.
10. Lu HR, Yan G-X, Gallacher DJ. A new biomarker–index of cardiac electrophysiological balance (iCEB)–plays an important role in drug-induced cardiac arrhythmias: beyond QT-prolongation and torsades de pointes (TdPs). J Pharmacol Toxicol Methods 2013; 68: 250-9.
11. Funada A, Hayashi K, Ino H, et al. Assessment of QT intervals and prevalence of short QT syndrome in Japan. Clin Cardiol 2008; 31: 270-274.
12. Hevia JC, Antzelevitch C, Bárzaga FT, et al. Tpeak-Tend and Tpeak-Tend dispersion as risk factors for ventricular tachycardia/ventricular fibrillation in patients with the Brugada syndrome. J Am College Cardiol 2006; 47: 1828-34.
13. Shimizu M, Ino H, Okeie K, et al. T‐peak to T‐end interval may be a better predictor of high‐risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002; 25: 335-9.
14. Alsancak Y. Kardiyak elektrofizyolojik denge indeksi ve Tp-E/qt oranı ile koroner kollateral dolaşım arasındaki ilişki. Selçuk Tıp Derg 2019; 35: 169-75.
15. Johnson M, Ashton C, Thompson J. Long term use of transcutaneous electrical nerve stimulation at Newcastle Pain Relief Clinic. J Royal Society Med 1992; 85: 267.
16. Sluka KA, Walsh D. Transcutaneous electrical nerve stimulation: basic science mechanisms and clinical effectiveness. J Pain 2003; 4: 109-21.
17. Wall PD, Sweet WH. Temporary abolition of pain in man. Science 1967; 155: 108-9.
18. Johnson M. Transcutaneous electrical nerve stimulation: mechanisms, clinical application and evidence. Reviews in Pain 2007; 1: 7-11.
19. King EW, Audette K, Athman GA, Nguyen HOX, Sluka KA, Fairbanks CA. Transcutaneous electrical nerve stimulation activates peripherally located alpha-2A adrenergic receptors. Pain 2005; 115: 364-73.
20. Wong RA, Jette DU. Changes in sympathetic tone associated with different forms of transcutaneous electrical nerve stimulation in healthy subjects. Physical Therapy 1984; 64: 478-82.
21. Sanderson JE, Tomlinson B, Lau MS, et al. The effect of transcutaneous electrical nerve stimulation (TENS) on autonomic cardiovascular reflexes. Clin Auton Res 1995; 5: 81-4.
22. Buonocore M, Mortara A, La Rovere M, Casale R. Cardiovascular effects of TENS: heart rate variability and plethysmographic wave evaluation in a group of normal subjects. Funct Neurol 1992; 7: 391-4.
23. Stein C, Dal Lago P, Ferreira JB, Casali KR, Plentz RDM. Transcutaneous electrical nerve stimulation at different frequencies on heart rate variability in healthy subjects. Auton Neurosci 2011; 165: 205-8.
24. Janes RD, Brandys JC, Hopkins DA, Johnstone DE, Murphy DA, Armour JA. Anatomy of human extrinsic cardiac nerves and ganglia. Am J Cardiol 1986; 57: 299-309.
25. Ağirman M, Aydin Hi. Effect of the conventional transcutaneous electrical nerve stimulation on heart rhythm. J Physical Med Rehabil Sci/Fiziksel Tıp ve Rehabil Bil Derg 2018; 21: 3.