Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure

Kulkarni, Kanchan; Stavrakis, Stavros; Elkholey, Khaled; Singh, Jagmeet P.; Parks, Kimberly A.; Armoundas, Antonis A.

doi:10.3389/fphys.2021.707724

Cited by 6 publications

(4 citation statements)

References 41 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Existing data show the beneficial effect of VNS in reducing inflammatory markers, and this may be the primary mechanism for improving clinical outcomes across many cardiovascular diseases. However, more studies are needed to elucidate the mechanisms linking the improvement of the inflammatory state following VNS with clinical outcomes in patients with heart failure, 59 myocardial ischemia, 59 and arrhythmias. 59 , 60 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State‐of‐the‐Art Review

Bazoukis,

Stavrakis,

Armoundas

2023

JAHA

Self Cite

View full text Add to dashboard Cite

Vagus nerve stimulation (VNS) has been found to exert anti‐inflammatory effects in different clinical settings and has been associated with improvement of clinical outcomes. However, evidence on the mechanistic link between the potential association of inflammatory status with clinical outcomes following VNS is scarce. This review aims to summarize the existing knowledge linking VNS with inflammation and its potential link with major outcomes in cardiovascular diseases, in both preclinical and clinical studies. Existing data show that in the setting of myocardial ischemia and reperfusion, VNS seems to reduce inflammation resulting in reduced infarct size and reduced incidence of ventricular arrhythmias during reperfusion. Furthermore, VNS has a protective role in vascular function following myocardial ischemia and reperfusion. Atrial fibrillation burden has also been reduced by VNS, whereas suppression of inflammation may be a potential mechanism for this effect. In the setting of heart failure, VNS was found to improve systolic function and reverse cardiac remodeling. In summary, existing experimental data show a reduction in inflammatory markers by VNS, which may cause improved clinical outcomes in cardiovascular diseases. However, more data are needed to evaluate the association between the inflammatory status with the clinical outcomes following VNS.

show abstract

Section: Discussionmentioning

confidence: 99%

“…However, more studies are needed to elucidate the mechanisms linking the improvement of the inflammatory state following VNS with clinical outcomes in patients with heart failure, 59 myocardial ischemia, 59 and arrhythmias. 59 , 60 …”

Section: Discussionmentioning

confidence: 99%

Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State‐of‐the‐Art Review

Bazoukis,

Stavrakis,

Armoundas

2023

JAHA

Self Cite

View full text Add to dashboard Cite

show abstract

“…Recent clinical studies have also demonstrated the potential of cardiac alternans as a biomarker of vagal stimulation treatment efficacy in patients with both atrial and ventricular tachyarrhythmias [ 12 , 49 ]. Cardiac alternans was shown to be modulated by both acute and chronic changes in electrophysiological substrate by vagus nerve stimulation.…”

Section: Future Scope: Can Atrial Alternans Guide Atrial Fibrillation...mentioning

confidence: 99%

Targeted Atrial Fibrillation Therapy and Risk Stratification Using Atrial Alternans

Muthavarapu

Christiani²,

Manga³

et al. 2023

JCDD

Self Cite

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most persistent arrhythmia today, with its prevalence increasing exponentially with the rising age of the population. Particularly at elevated heart rates, a functional abnormality known as cardiac alternans can occur prior to the onset of lethal arrhythmias. Cardiac alternans are a beat-to-beat oscillation of electrical activity and the force of cardiac muscle contraction. Extensive evidence has demonstrated that microvolt T-wave alternans can predict ventricular fibrillation vulnerability and the risk of sudden cardiac death. The majority of our knowledge of the mechanisms of alternans stems from studies of ventricular electrophysiology, although recent studies offer promising evidence of the potential of atrial alternans in predicting the risk of AF. Exciting preclinical and clinical studies have demonstrated a link between atrial alternans and the onset of atrial tachyarrhythmias. Here, we provide a comprehensive review of the clinical utility of atrial alternans in identifying the risk and guiding treatment of AF.

show abstract

“…Even though treatment of cardiac arrhythmias through automatic modulation has proven results preclinically, large randomized clinical trials have shown mixed results ( Premchand et al, 2014 ; Zannad et al, 2015 ; Gold et al, 2016 ; Stavrakis et al, 2020b ), highlighting the need for optimized biomarkers enabling appropriate patient selection. Yet, recent studies have demonstrated that vagal stimulation can modulate cardiac electrophysiological properties ( Kulkarni et al, 2018b ; Lee et al, 2018 ) including both atrial and ventricular alternans ( Kulkarni et al, 2021b , c ) as well as reduce AF burden ( Qin and Singh, 2020 ; Stavrakis et al, 2020b ).…”

Section: Management Of Atrial Arrhythmiasmentioning

confidence: 99%

Advances in Cardiac Pacing: Arrhythmia Prediction, Prevention and Control Strategies

et al. 2021

Self Cite

View full text Add to dashboard Cite

Cardiac arrhythmias constitute a tremendous burden on healthcare and are the leading cause of mortality worldwide. An alarming number of people have been reported to manifest sudden cardiac death as the first symptom of cardiac arrhythmias, accounting for about 20% of all deaths annually. Furthermore, patients prone to atrial tachyarrhythmias such as atrial flutter and fibrillation often have associated comorbidities including hypertension, ischemic heart disease, valvular cardiomyopathy and increased risk of stroke. Technological advances in electrical stimulation and sensing modalities have led to the proliferation of medical devices including pacemakers and implantable defibrillators, aiming to restore normal cardiac rhythm. However, given the complex spatiotemporal dynamics and non-linearity of the human heart, predicting the onset of arrhythmias and preventing the transition from steady state to unstable rhythms has been an extremely challenging task. Defibrillatory shocks still remain the primary clinical intervention for lethal ventricular arrhythmias, yet patients with implantable cardioverter defibrillators often suffer from inappropriate shocks due to false positives and reduced quality of life. Here, we aim to present a comprehensive review of the current advances in cardiac arrhythmia prediction, prevention and control strategies. We provide an overview of traditional clinical arrhythmia management methods and describe promising potential pacing techniques for predicting the onset of abnormal rhythms and effectively suppressing cardiac arrhythmias. We also offer a clinical perspective on bridging the gap between basic and clinical science that would aid in the assimilation of promising anti-arrhythmic pacing strategies.

show abstract

Microvolt T-Wave Alternans Is Modulated by Acute Low-Level Tragus Stimulation in Patients With Ischemic Cardiomyopathy and Heart Failure

Cited by 6 publications

References 41 publications

Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State‐of‐the‐Art Review

Vagus Nerve Stimulation and Inflammation in Cardiovascular Disease: A State‐of‐the‐Art Review

Targeted Atrial Fibrillation Therapy and Risk Stratification Using Atrial Alternans

Advances in Cardiac Pacing: Arrhythmia Prediction, Prevention and Control Strategies

Contact Info

Product

Resources

About