Cardiovascular autonomic effects of vagus nerve stimulation

Garamendi-Ruíz, Iñigo; Gómez‐Esteban, Juan Carlos

doi:10.1007/s10286-017-0477-8

Cited by 34 publications

(20 citation statements)

References 82 publications

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“…When studying interictal HRV before and after implantation, a number of studies reported findings indicating a shift back toward increased parasympathetic activity with VNS; with a similar shift noted in healthy subjects stimulated using transcutaneous VNS . However, multiple other studies failed to find a statistically significant difference before and after VNS treatment . One study reported that VNS actually decreased HRV .…”

Section: Effects Of Treatment On Interictal Hrvmentioning

confidence: 98%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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Our objective was to critically evaluate the literature surrounding heart rate variability (HRV) in people with epilepsy and to make recommendations as to how future research could be directed to facilitate and accelerate integration into clinical practice. We reviewed relevant HRV publications including those involving human subjects with seizures. HRV has been studied in patients with epilepsy for more than 30 years and, overall, patients with epilepsy display altered interictal HRV, suggesting a shift in autonomic balance toward sympathetic dominance. This derangement appears more severe in those with temporal lobe epilepsy and drug-resistant epilepsy. Normal diurnal variation in HRV is also disturbed in at least some people with epilepsy, but this aspect has received less study. Some therapeutic interventions, including vagus nerve stimulation and antiepileptic medications, may partially normalize altered HRV, but studies in this area are sometimes contradictory. During seizures, the changes in HRV may be complex, but the general trend is toward a further increase in sympathetic overactivity. Research in HRV in people with epilepsy has been limited by inconsistent experimental protocols and studies that are often underpowered. HRV measurement has the potential to aid clinical epilepsy management in several possible ways. HRV may be useful in predicting which patients are likely to benefit from surgical interventions such as vagus nerve stimulation and focal cerebral resection. As well, HRV could eventually have utility as a biomarker of risk for sudden unexpected death in epilepsy (SUDEP). However, at present, the inconsistent measurement protocols used in research are hindering translation into clinical practice. A minimum protocol for HRV evaluation, to be used in all studies involving epilepsy patients, is necessary to eventually allow HRV to become a useful tool for clinicians. We propose a straightforward protocol, involving 5-minute measurements of root mean square of successive differences in wakefulness and light sleep.

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Section: Effects Of Treatment On Interictal Hrvmentioning

confidence: 98%

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

2018

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“…These fibers projecting to the NTS will activate and modulate several simple and complex loops and circuitry (i.e., autonomic brainstem and forebrain loops), centrally in a bottom-up mode, and trough up-down reactions, the HPA axis and, in the periphery, immune tracts as the CAP [23][24][25] . Traditionally and otherwise indicated only the left branch of the ABVN is stimulated so that there is less influence on the heart rate, since the left VN innervates the atrioventricular node and the right VN innervates the sinoatrial node controlling the pace-making function of the heart 26 .…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Vagus Nerve Stimulation in Private Healthcare Center: A Small-Scale Investigation Targeting Anxiety, Irritable Bowel Syndrome and Chronic Pain

Grolaux¹

2019

J Neurol Neuromed

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Background: Generalized anxiety disorder (GAD), chronic pain (CP) and irritable bowel syndrome (IBS) are debilitating inflammatory disorders that are frequently seen in primary care facilities but not sufficiently addressed by classical medical treatments. Transcutaneous vagus nerve stimulation (tVNS) is a promising therapeutic tool for a wide range of conditions that showed already encouraging clinical results. However, the effects of tVNS, on these disorders, GAD, IBS and CP,were not yet explored in the context of an investigation conducted in a private healthcare center.Objective: In an uncontrolled, open label, small investigation scale study, we investigated the feasibility, safety and the effects of tVNS for patients suffering from GAD, CP and IBS in a multidisciplinary healthcare center. Methods:The effects of tVNS on GAD, CP and IBS in 10 participants (anxiety, 40%; chronic pain, 30%; IBS, 30%) were investigated during a 4-week period and a 2-month follow-up. GAD, CP and IBS were assessed using the Generalized Anxiety Disorder GAD-7, the Brief Pain Inventory Short Form questionnaire and the Irritable Bowel Syndrome Severity Scoring System. Transcutaneous vagus nerve stimulation was performed using a transcutaneous electrical nerve stimulation device and ear clip electrodes plugged in the concha area of the ear. All participants, received a bi-weekly 30-minute stimulation for 4 weeks. The tVNS parameters, (GAD: 20Hz-80µs), (CP: 5Hz-200 µs), (IBS: 3Hz-250µs), were set for each group to target different physiological effects meditated by the vagus nerve. Results:The anxiety and the IBS group showed a non-statistically significant improvement but an improved clinical status (mean score from "severe" to "moderate") both at the end of the stimulation period (4 weeks) and at 2-month follow-up. The CP group didn't show any significant clinical improvement (mean score from "moderate" to "moderate"). Furthermore, tVNS was demonstrated to be likely safe and was well tolerated. Conclusions:Due to low sample size, this study failed to demonstrate significant clinical effects of tVNS on GAD, IBS and CP. However, trend analysis may carefully suggest tVNS to be a noteworthy clinical alternative to be used in private healthcare center in the treatment of chronic inflammation disorders like GAD and IBS. Acute tVNS was well-tolerated and is likely safe. Powerful, double-blind controlled studies are needed to support the use of tVNS for these disorders. Clinical Trial Registration: http:/www.clinicaltrials.gov. Unique identifier: NCT03440255. Abbreviations α7nAChR, alpha7 nicotinic acetylcholine receptor; ABVN, auricular branch of the vagus nerve; CAN, central autonomic network; CAP, cholinergic anti-inflammatory pathway; CP, chronic pain; DMVN, dorsal motor nucleus of the vagus; GABA, γ-aminobutyric acid; GAD, general

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“…However, according to anatomical evidence, the effect of left-sided surgery on heart rate may also be more obvious compared with right-sided surgery. (10,24,25) With left-sided surgery, the operation time is slightly longer, but this difference is not signi cant.…”

Section: Discussionmentioning

confidence: 98%

Effect of Vagal Nerve Protection on Heart Rate in Patients Undergoing Minimally Invasive Lobectomy

Liu

Shang

Chen

et al. 2021

Preprint

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OBJECTIVES: As a common malignant tumor worldwide, lung cancer receives substantial attention from specialists. Surgery occupies an important position in lung cancer treatment, particularly early treatment. To better improve quality of life for patients after surgery, we report our surgical approach to protect vagal nerve branches during lung cancer surgery, especially the thoracic branch, which is important to maintain a suitable heart rate after surgery.METHODS: We selected 40 patients who underwent lobectomy and systematic dissection of mediastinal lymph nodes during the same period. Patients were divided into two groups: the control group (traditional surgery) and the experimental group (surgery with vagal nerve/vagal branch protection). During surgery, vagal nerve function was preserved as much as possible.RESULTS: There were no significant differences in operation time, intraoperative bleeding, postoperative pain, and discharge time between the two groups. Heart rate at discharge was significantly reduced in the experimental group compared with the control group (75.30 bpm vs. 86.00 bpm, respectively; P = 0.038). Heart rate at discharge was compared with heart rate at admission in both groups. The change in heart rate after surgery compared with heart rate at admission was less marked in the experimental group compared with the control group.CONCLUSIONS: Preserving the thoracic and cardiac branches of the vagus nerve during surgery can effectively reduce heart rate in patients after surgery and maintain pre-surgical heart rate.

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Cardiovascular autonomic effects of vagus nerve stimulation

Cited by 34 publications

References 82 publications

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Heart rate variability measurement in epilepsy: How can we move from research to clinical practice?

Transcutaneous Vagus Nerve Stimulation in Private Healthcare Center: A Small-Scale Investigation Targeting Anxiety, Irritable Bowel Syndrome and Chronic Pain

Effect of Vagal Nerve Protection on Heart Rate in Patients Undergoing Minimally Invasive Lobectomy

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