期刊
CLINICAL AUTONOMIC RESEARCH
卷 31, 期 3, 页码 453-462出版社
SPRINGER HEIDELBERG
DOI: 10.1007/s10286-021-00780-y
关键词
Autonomic regulation therapy; Baroreflex sensitivity; Heart failure; Heart rate recovery; Heart rate turbulence; Vagus nerve stimulation
资金
- Cyberonics/LivaNova USA
- LivaNova USA
This study shows that chronic high-intensity vagus nerve stimulation improves intrinsic heart rate recovery, heart rate turbulence slope, and left ventricular ejection fraction over a period of 3 years. The correlated favorable effects on heart rate turbulence slope suggest enhanced baroreceptor function in response to vagus nerve stimulation.
Purpose Disturbed autonomic function is implicated in high mortality rates in heart failure patients. High-intensity vagus nerve stimulation therapy was shown to improve intrinsic heart rate recovery and left ventricular ejection fraction over a period of 1 year. Whether these beneficial effects are sustained across multiple years and are related to improved baroreceptor response was unknown. Methods All patients (n = 21) enrolled in the ANTHEM-HF clinical trial (NCT01823887, registered 4/3/2013) with 24 h ambulatory electrocardiograms at all time points and 54 normal subjects (PhysioNet database) were included. Intrinsic heart rate recovery, based on similar to 2000 spontaneous daily activity-induced heart rate acceleration/deceleration events per patient, was analyzed at screening and after 12, 24, and 36 months of chronic vagus nerve stimulation therapy (10 or 5 Hz, 250 mu s pulse width, 18% duty cycle, maximum tolerable current amplitude). Results In response to chronic high-intensity vagus nerve stimulation (>= 2.0 mA), intrinsic heart rate recovery (all time points, p < 0.0001), heart rate turbulence slope, an indicator of baroreceptor reflex gain (all, p <= 0.02), and left ventricular ejection fraction (all, p <= 0.04) were improved over screening at 12, 24, and 36 months. Intrinsic heart rate recovery and heart rate turbulence slope were inversely correlated at both screening (r = 0.67, p < 0.002) and 36 months (r = 0.78, p < 0.005). Conclusion This non-randomized study provides evidence of an association between improvement in intrinsic heart rate recovery and left ventricular ejection fraction during high-intensity vagus nerve stimulation for a period of >= 3 years. Correlated favorable effects on heart rate turbulence slope implicate enhanced baroreceptor function in response to chronic, continuously cyclic vagus nerve stimulation as a physiologic mechanism.
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