Vague nerve stimulation in chronic heart failure: is it worth it?

Abstract

In heart failure the major pathophysiology changes are enhanced sympathetic nervous system activity and reduced parasympathetic activation. Despite advances in pharmacologic treatment and interventional therapies such as implantable devices, mortality and morbidity in patients with advanced heart failure is still higher. In the last three decades the novel interventional and device-based therapies aim to restore cardiac autonomic balance by neuromodulation. Chronic vague nerve stimulation (VNS) is a neuromodulator method proposed as a new potential therapy in patients with heart failure. Results of preclinical animal studies and early clinical trials have demonstrated the safety and efficacy of this therapy in heart failure. Although a favorable long-term safety profile was found in human, improvements in the efficacy endpoints in patients with heart failure by VNS are controversially, as demonstrated by one of the largest recently published trial. Despite that VNS does not reduce left ventricular end-systolic volume index, the rate of death or heart failure events in chronic heart failure patients, this new treatment improved quality of life, NYHA functional class, and 6-min walking distance. Large randomized clinical studies are necessary to evaluate the clinical role of this new therapeutic approach in chronic heart failure.