Mariana Floria Mihaela Grecu Grigore Tinică

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.

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Keywords

heart failure, vague nerve stimulation, neuromodulation, minim invasive

References
1. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013; 15(8):1070-1118.
2. De Ferrari GM, Stolen C, Tuinenburg AE, et al. Long-term vagal stimulation for heart failure: Eighteen month results from the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) trial. Int J Cardiol 2017; pii:S0167-5273(17)31295-0.
3. Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec 1997; 247:289–298.
4. Armour JA. Potential clinical relevance of the ‘little brain on the mammalian heart. Exp Physiol 2008; 93:165–176.
5. De Ferrari GM, Schwartz PJ. Vagus nerve stimulation: from pre-clinical to clinical application: challenges and future directions. Heart Fail Rev 2011; 16(2):195-203.
6. Li M, Zheng C, Sato T, Kawada T, Sugimachi M, Sunagawa K. Vagal nerve stimulation markedly improves long-term survival after chronic heart failure in rats. Circulation 2004; 109(1):120-124.
7. Zhang Y, Popovic ZB, Bibevski S, et al. Chronic vagus nerve stimulation improves autonomic control and attenuates systemic inflammation and heart failure progression in a canine high–rate pacing model. Circulation 2009; 2:692–699.
8. Hamann JJ, Ruble SB, Stolen C, et al. Vagus nerve stimulation improves left ventricular function in a canine model of chronic heart failure. Eur J Heart Fail 2013; 15:1319–1326.
9. Schwartz PJ. Vagal stimulation for heart diseases: from animals to men. - An example of translational cardiology. Circ J 2011; 75(1):20-27.
10. Schwartz PJ, La Rovere MT, De Ferrari GM, Mann DL. Autonomic modulation for the management of patients with chronic heart failure. Circ Heart Fail 2015; 8(3):619-628.
11. Schwartz PJ, De Ferrari GM, Sanzo A, et al. Long term vagal stimulation in patients with advanced heart failure: first experience in man. Eur J Heart Fail 2008; 10:884–891.
12. Premchand RK, Sharma K, Mittal S, et al. Autonomic regulation therapy via left or right cervical vagus nerve stimulation in patients with chronic heart failure: results of the ANTHEM-HF trial. J Card Fail 2014; 20:808–816.
13. Zannad F, De Ferrari GM, Tuinenburg AE, et al. Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR Heart Failure (NECTAR-HF) randomized controlled trial. Eur Heart J 2015; 36:425–433.
14. De Ferrari GM. Vagal stimulation in heart failure. J Cardiovasc Transl Res 2014; 7(3):310-320.
15. Castoro MA, Yoo PB, Hincapie JG, et al. Excitation properties of the right cervical vagus nerve in adult dogs. Exp Neurol 2011; 227:62–68.
16. Hauptman PJ, Schwartz PJ, Gold MR, et al. Rationale and study design of the increase of vagal tone in heart failure study: INOVATE-HF. Am Heart J 2012; 163:954–962.e1.
17. Gold MR, Van Veldhuisen DJ, Hauptman PJ, et al. Vagus Nerve Stimulation for the Treatment of Heart Failure: The INOVATE-HF Trial. J Am Coll Cardiol 2016; 68(2):149-158.
18. Libbus I, Nearing BD, Amurthur B, Ken Knight BH, Verrier RL. Quantitative evaluation of heartbeat interval time series using Poincaré analysis reveals distinct patterns of heart rate dynamics during cycles of vagus nerve stimulation in patients with heart failure. J Electrocardiol 2017; pii: S0022-0736(17)30181-30184.
19. De Ferrari GM, Crijns HJ, Borggrefe M, et al. Chronic vagus nerve stimulation: a new and promising therapeutic approach for chronic heart failure. Eur Heart J 2011; 32(7):847-855.
20. Akdemir B, Benditt DG. Vagus nerve stimulation: An evolving adjunctive treatment for cardiac disease. Anatol J Cardiol 2016; 16(10):804-810.
How to Cite
Floria, M., Grecu, M., & Tinică, G. (2017). Vague nerve stimulation in chronic heart failure: is it worth it?. Archive of Clinical Cases, 4(3), Arch Clin Cases 2017; 4(3):181-185. https://doi.org/10.22551/2017.16.0403.10111
Section
Reviews

How to Cite

Floria, M., Grecu, M., & Tinică, G. (2017). Vague nerve stimulation in chronic heart failure: is it worth it?. Archive of Clinical Cases, 4(3), Arch Clin Cases 2017; 4(3):181-185. https://doi.org/10.22551/2017.16.0403.10111