Electrocardiography Assessment of Sympatico–Vagal Balance during Resting and Pain Using the Texas Instruments ADS1299

Donghua Liao*, Rasmus B. Nedergaard, Misbah Unnisa, Soumya J. Mahapatra, Mahya Faghih, Anna E. Phillips, Dhiraj Yadav, Vikesh K. Singh, Søren S. Olesen, Rupjyoti Talukdar, Pramod K. Garg, Imran K. Niazi, Christina Brock, Asbjørn M. Drewes, on behalf of the P-QST Consortium

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

2 Citations (Scopus)
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Sympatico-vagal balance is essential for regulating cardiac electrophysiology and plays an important role in arrhythmogenic conditions. Various noninvasive methods, including electrocardiography (ECG), have been used for clinical assessment of the sympatico-vagal balance. This study aimed to use a custom-designed wearable device to record ECG and ECG-based cardiac function biomarkers to assess sympatico-vagal balance during tonic pain in healthy controls. Nineteen healthy volunteers were included for the ECG measurements using the custom-designed amplifier based on the Texas Instruments ADS1299. The ECG-based biomarkers of the sympatico-vagal balance, (including heart rate variability, deceleration capacity of the heart rate, and periodic repolarization dynamic), were calculated and compared between resting and pain conditions (tonic pain). The custom-designed device provided technically satisfactory ECG recordings. During exposure to tonic pain, the periodic repolarization dynamics increased significantly ( p = 0.02), indicating enhancement of sympathetic nervous activity. This study showed that custom-designed wearable devices can potentially be useful in healthcare as a new telemetry technology. The ECG-based novel biomarkers, including periodic repolarization dynamic and deceleration capacity of heart rate, can be used to identify the cold pressor-induced activation of sympathetic and parasympathetic systems, making it useful for future studies on pain-evoked biomarkers.

Original languageEnglish
Article number205
Issue number2
Publication statusPublished - 3 Feb 2023

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© 2023 by the authors.


  • biomarkers
  • cold pressor test
  • electrocardiography (ECG)
  • sympatico–vagal balance


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