“…The observed effects of VNS on RSA magnitude may result from (1) activation of brainstem loop via stimulation of afferent fibers (Paintal, 1973; Kubin et al., 2006; Osharina et al., 2006), (2) alteration of vagal afferent tone (Fouad et al., 1984; Pomeranz et al., 1985; Hayano et al., 1991), which modulates specific tonic and phasic parasympathetic efferent fibers (Jones et al., 1998; Golberger et al., 1994; 2001; Hayano & Yasuma, 2003), (3) activation of efferent vagal fibers in the case of partial VNS anodal block (D’Angelo, 1978; Tai & Jiang, 1994; Jones et al., 1995; Vuckovic et al., 2005) resulting in disturbance or abolition of physiologic efferent phasic and tonic firing (Guz et al., 1964; Banzett et al., 1999; Zefirov et al., 2006) or additive excitatory input to the heart, or (4) a combination of both efferent and afferent vagal fiber stimulation. In addition, changes in respiration due to VNS could also modify RSA.…”