Cardiac responses of vagus nerve stimulation: Intraoperative bradycardia and subsequent chronic stimulation

Ardesch, J.J.; Buschman, H.P.J.; Burgh, Pieter H. van der; Wagener-Schimmel, L.J.J.C.; Aa, H.E. van der; Hageman, G.

doi:10.1016/j.clineuro.2007.07.024

Cited by 58 publications

(40 citation statements)

References 16 publications

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“…The currents used for VNS for epilepsy are designed to activate A fibres, but if they also activate B fibers during intraoperative lead testing at 20 Hz, bradycardia is observed [22]. In an earlier report, stimulation of the left vagus at 25 Hz for 5 s in humans caused the heart to stop beating [16].…”

Section: Discussionmentioning

confidence: 99%

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

et al. 2017

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Vagal nerve stimulation is widely used therapeutically but the fiber groups activated are often unknown. Aim: To establish a simple protocol to define stimulus thresholds for vagal A, B and C fibers. Methods:The intact left or right cervical vagus was stimulated with 0.1 ms pulses in spontaneously breathing anesthetized rats. Heart and respiratory rate responses to vagal stimulation were recorded. The vagus was subsequently cut distally, and mass action potentials to the same stimuli were recorded. Results: Stimulating at either 50 Hz for 2 s or 2 Hz for 10 s at experimentally determined strengths revealed A, B and C fiber thresholds that were related to respiratory and heart rate changes. Conclusion: Our simple protocol discriminates vagal A, B and C fiber thresholds in vivo.

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Section: Discussionmentioning

confidence: 99%

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

et al. 2017

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“…Arrhythmia, including asystole and bradycardia, is an important but rare complication that has been reported in the literature. [3][4][5]35,40 Possible reasons for this phenomenon could be polarity reversal of the leads during implantation causing efferent instead of afferent stimulation, 44 indirect stimulation of the cervical cardiac nerves, technical malfunction of the device, or accidental over-manipulation of the nerve since placing the spiral (Cyberonics) lead around the nerve can be difficult due to anatomical variations. The CardioFit cuff lead is subjectively easier to apply because of its design and requires less manipulation of the vagus nerve as a whole.…”

Section: Discussionmentioning

confidence: 99%

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Révész

Rydenhag

Ben‐Menachem

2016

PED

143

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OBJECTIVE The goal of this paper was to investigate surgical and hardware complications in a longitudinal retrospective study. METHODS The authors of this registry study analyzed the surgical and hardware complications in 247 patients who underwent the implantation of a vagus nerve stimulation (VNS) device between 1990 and 2014. The mean follow-up time was 12 years. RESULTS In total, 497 procedures were performed for 247 primary VNS implantations. Complications related to surgery occurred in 8.6% of all implantation procedures that were performed. The respective rate for hardware complications was 3.7%. Surgical complications included postoperative hematoma in 1.9%, infection in 2.6%, vocal cord palsy in 1.4%, lower facial weakness in 0.2%, pain and sensory-related complications in 1.4%, aseptic reaction in 0.2%, cable discomfort in 0.2%, surgical cable break in 0.2%, oversized stimulator pocket in 0.2%, and battery displacement in 0.2% of patients. Hardware-related complications included lead fracture/malfunction in 3.0%, spontaneous VNS turn-on in 0.2%, and lead disconnection in 0.2% of patients. CONCLUSIONS VNS implantation is a relatively safe procedure, but it still involves certain risks. The most common complications are postoperative hematoma, infection, and vocal cord palsy. Although their occurrence rates are rather low at about 2%, these complications may cause major suffering and even be life threatening. To reduce complications, it is important to have a long-term perspective. The 25 years of follow-up of this study is of great strength considering that VNS can be a life-long treatment for many patients. Thus, it is important to include repeated surgeries such as battery and lead replacements, given that complications also may occur with these surgeries.

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“…Despite the close proximity of VNS and centers controlling cardiovascular function initial studies in both animals and humans failed to demonstrate a relevant effect on cardiac function. Recent studies produced inconsistent results [7,8,11,13,15], mostly focusing on severe incidents associated with the intraoperative lead test during VNS implantation [1,3,5,6,14]. All patients made an uneventful recovery (Table 1).…”

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confidence: 87%

Late-onset cardiac arrhythmia associated with vagus nerve stimulation

et al. 2009

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Cardiac responses of vagus nerve stimulation: Intraoperative bradycardia and subsequent chronic stimulation

Cited by 58 publications

References 16 publications

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

Calibration of Thresholds for Functional Engagement of Vagal A, B and C Fiber Groups In Vivo

Complications and safety of vagus nerve stimulation: 25 years of experience at a single center

Late-onset cardiac arrhythmia associated with vagus nerve stimulation

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