Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease

Carandina, Angelica; Rodrigues, Gabriel Dias; Francesco, Pietro Di; Filtz, Annalisa; Bellocchi, Chiara; Furlan, Ludovico; Carugo, Stefano; Montano, Nicola; Tobaldini, Eleonora

doi:10.1016/j.autneu.2021.102893

Cited by 34 publications

(24 citation statements)

References 80 publications

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“…The mechanism for the HR suppression via tVNS is suggested to be the activation of excitatory inputs to the caudal ventrolateral medulla medulla by afferent fibers via the NTS; this would consequently suppress the rostral ventrolateral medulla, the source of excitatory drive of the sympathetic nervous system [ 30 ]. Previous studies indicate that tVNS activates a wide range of brain regions involved in the autonomic nervous system control [ 13 , 14 , 31 ] and that the heart-evoked potential, which reflects the cardiac interoceptive input, increases in these areas during tVNS.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, the HR rebound after the termination of stimulation in Experiment 1 was not due to homeostatic plasticity, but rather to the physiological reaction to the verbal NRS response. In animal studies on the application of tVNS for cardiac disease, high-intensity stimulation to vagal efferent fibers induces atrial fibrillation and low-intensity VNS has been shown to suppress atrial fibrillation [ 7 , 10 , 24 , 30 , 33 , 34 , 35 , 36 ]. However, atrial fibrillation cannot be induced unless the HR is reduced by 40% or more [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

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Effects of Stimulus Frequency, Intensity, and Sex on the Autonomic Response to Transcutaneous Vagus Nerve Stimulation

et al. 2022

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This study aimed to determine how transcutaneous vagus nerve stimulation (tVNS) alters autonomic nervous activity by comparing the effects of different tVNS frequencies and current intensities. We also investigated the sex-dependent autonomic response to tVNS. Thirty-five healthy adult participants were stimulated using a tVNS stimulator at the left cymba conchae while sitting on a reclining chair; tVNS-induced waveform changes were then recorded for different stimulus frequencies (Experiment 1: 3.0 mA at 100 Hz, 25 Hz, 10 Hz, 1 Hz, and 0 Hz (no stimulation)) and current intensities (Experiment 2: 100 Hz at 3.0 mA, 1.0 mA, 0.2 mA (below sensory threshold), and 0 mA (no stimulation)) using an electrocardiogram. Pulse widths were set at 250 µs in both experiment 1 and 2. Changes in heart rate (HR), root-mean-square of the difference between two successive R waves (RMSSD), and the ratio between low-frequency (LF) (0.04–0.15 Hz) and high-frequency (HF) (0.15–0.40 Hz) bands (LF/HF) in spectral analysis, which indicates sympathetic and parasympathetic activity, respectively, in heart rate variability (HRV), were recorded for analysis. Although stimulation at all frequencies significantly reduced HR (p = 0.001), stimulation at 100 Hz had the most pronounced effect (p = 0.001) in Experiment 1 and was revealed to be required to deliver at 3.0 mA in Experiment 2 (p = 0.003). Additionally, participants with higher baseline sympathetic activity experienced higher parasympathetic response during stimulation, and sex differences may exist in the autonomic responses by the application of tVNS. Therefore, our findings suggest that optimal autonomic changes induced by tVNS to the left cymba conchae vary depending on stimulating parameters and sex.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Stimulus Frequency, Intensity, and Sex on the Autonomic Response to Transcutaneous Vagus Nerve Stimulation

et al. 2022

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“…Several other studies found a decreased HRV in SLE [ 126 , 127 , 128 , 129 , 130 ]. It is widely known that ANS dysfunction is associated with the development of cardiovascular diseases (CVDs), where the sympathetic activity is a mediator of both the onset and progression of CVDs while on the other hand, the parasympathetic control seems to have a protective role with reduced mortality in CVDs [ 131 , 132 , 133 ]. In SLE patients, CVDs are a high cause of mortality, especially related to atherosclerosis, and CVD risk is doubled with respect to the general population [ 134 , 135 ].…”

Section: Autonomic Nervous System and Its Interplay With Inflammation...mentioning

confidence: 99%

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

Bellocchi

Carandina

Montinaro

et al. 2022

IJMS

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The autonomic nervous system (ANS) and the immune system are deeply interrelated. The ANS regulates both innate and adaptive immunity through the sympathetic and parasympathetic branches, and an imbalance in this system can determine an altered inflammatory response as typically observed in chronic conditions such as systemic autoimmune diseases. Rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis all show a dysfunction of the ANS that is mutually related to the increase in inflammation and cardiovascular risk. Moreover, an interaction between ANS and the gut microbiota has direct effects on inflammation homeostasis. Recently vagal stimulation techniques have emerged as an unprecedented possibility to reduce ANS dysfunction, especially in chronic diseases characterized by pain and a decreased quality of life as well as in chronic inflammation.

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“…This includes pharmacologic therapies directed toward modulation of sympathetic nervous system activation such as beta-blockers, while recognizing limitations of off-target action and long-term side effects. Nonpharmacologic interventions such as vagal nerve stimulation, renal and carotid body denervation, and stellectomy are other options; however, they are invasive, expensive, and also associated with side effects ( 2 ). Furthermore, there are limitations with human model systems including heart rate, heart rate variability (HRV), plasma catecholamines, and noradrenaline spillover that can have limitations in terms of largescale implementation, can be confounded in certain states such as heart failure (HF), and have age- and sex-specific influences that need to be considered ( 3 ).…”

mentioning

confidence: 99%

Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation

Mehra

Tjurmina

Ajijola

et al. 2022

JACC: Basic to Translational Science

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Effects of transcutaneous auricular vagus nerve stimulation on cardiovascular autonomic control in health and disease

Cited by 34 publications

References 80 publications

Effects of Stimulus Frequency, Intensity, and Sex on the Autonomic Response to Transcutaneous Vagus Nerve Stimulation

Effects of Stimulus Frequency, Intensity, and Sex on the Autonomic Response to Transcutaneous Vagus Nerve Stimulation

The Interplay between Autonomic Nervous System and Inflammation across Systemic Autoimmune Diseases

Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation

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