Heart Rate Clinical Trial
Official title:
Shoulder Transcutaneous Electric Nerve Stimulation Decelerates Heart Rhythm of Subjects Via Potentiating Vagal Tone
Transcutaneous electric nerve stimulation (TENS) is widely used for the treatment of adhesive
capsulitis, nevertheless, its potential impact on heart physiology has not been well
established.
The investigator explored if TENS at shoulder region affect heart rhythm and the machinery
involved.
Subjects were stratified into groups received sham stimulation (TENS-S) and TENS on either
the right (TENS-R) or left (TENS-L) shoulder. A built-in waveform for treating adhesive
capsulitis with a maximal tolerable intensity below the pain threshold was applied to
subjects form a commercial TENS equipment for 5 min. The electrocardiogram (ECG) and heart
rate (HR) were continuously recorded and the ECG was off-line transferred into power spectrum
for analysis.
Study design This study complied with the Declaration of Helsinki, and all protocols were
approved by the ethics committee of Taoyuan General Hospital, Ministry of Health and Welfare,
Taoyuan, Taiwan. All the participants gave written informed consent before experiments. 32
subjects (20-51 years old) were included in the statistical analysis. Participants were
eligible if they have cardiovascular illnesses, major mental conditions, or severe
inflammation. Participants were allocated to groups that received sham stimulation (TENS-S)
and TENS on the right and left shoulder (TENS-R and TENS-L, respectively).
ECG and HR recordings Using a monitor lead, electrocardiogram (ECG) was recorded through
electrodes connected to a recording system with a sampling rate of 5,000 samples/sec. The ECG
and the HR calculated by a built-in rate meter were continuously recorded and displayed on a
monitor. For TENS caused marked artifacts in ECG tracings, HR derived from ECG were confirmed
off-line by manual examination.
TENS stimulation To mimicking clinical scenarios, a commercial TENS equipment was used
throughout this study. A built-in waveform recommended for treating capsulitis in the user's
manual was used for stimulation (triple pulses with 1 ms pulse durations separated by a 1 ms
intervals were ramps up and down between 2 to 10 Hz within 20 sec for 3 min and then ramps up
from 10 to 200 Hz within 20 sec and kept at 200 Hz for 2 min; supplementary data 1). The
current intensity was adjusted to the maximal tolerance level below the pain threshold. A
pair of stimulating electrode was placed in the front of the should at the level of the
sternal notch at about 2 finger-width from the mid-clavicle line, and a pair of dispersive
electrode was placed at the back of shoulder opposite to the stimulating electrodes.
Participants kept a stationary supine position and was asked to refrain from moving during
recording. Before the stimulation, there was an equilibrium period for at least 10 min, and
then the recording started. TENS was turned on for 5 min at 5 min after the baseline
recording, and the recording continued until 10 min after the offset of stimulation.
Parameters of the sham stimulation was identical to TENS stimulation on the right shoulder
excepting the equipment was left un-powered.
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