Transcutaneous electrical nerve stimulation attenuates cardiac sympathetic drive in heart failure: a ¹²³MIBG myocardial scintigraphy randomized controlled trial

Abstract

Cardiac sympathetic overdrive provides inotropic support to the failing heart. However, as myocardial insult evolves, this compensatory response impairs contractile function and constitutes an independent mortality predictor and a primary target in the treatment of heart failure (HF). In this prospective, randomized, double-blind, controlled crossover trial, we proposed cervicothoracic transcutaneous electrical nerve stimulation (CTENS) as a nonpharmacological therapy on cardiac sympathetic activity in patients with HF. Seventeen patients with HF were randomly assigned to an in-home CTENS (30 min twice daily, 80-Hz frequency, and 150-μs pulse duration) or a control intervention (Sham) for 14 consecutive days. Following a 60-day washout phase, patients were crossed over to the opposite intervention. The heart-to-mediastinum ratio (HMR) and washout rate (WR) (indexes of sympathetic innervation density and activity from planar 123iodo-metaiodobenzylguanidine myocardial scintigraphy images, respectively), as well as blood pressure (BP) and heart rate (HR), were quantified before and after each intervention. HMR, BP, and HR did not change throughout the study. Nonetheless, CTENS reduced WR (CTENS −4 ± 10 vs. Sham +5 ± 15%, P = 0.03) when compared with Sham. When allocated in two independent groups, preserved (PCSI, HMR > 1.6, n = 10) and impaired cardiac sympathetic innervation (ICSI, HRM ≤1.6, n = 7), PCSI patients showed an important attenuation of WR (−11 ± 9 vs. Sham +8 ± 19%, P = 0.007) after CTENS. Nonetheless, neither Sham nor CTENS evoked changes in WR of the ICSI patients ( P > 0.05). These findings indicate that CTENS attenuates the cardiac sympathetic overdrive in patients with HF and a preserved innervation constitutes an essential factor for this beneficial neuromodulatory impact. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Identifier: NCT03354689. NEW & NOTEWORTHY We found that short-term cervicothoracic transcutaneous electrical nerve stimulation (CTENS) attenuates cardiac sympathetic overdrive in patients with heart failure and a preserved autonomic innervation may constitute an essential factor to maximize this beneficial neuromodulatory effect. CTENS then emerges as an alternative noninvasive and nonpharmacological strategy to attenuate exaggerated cardiac sympathetic drive in patients with heart failure.

Spinal Anesthesia Reduces Myocardial Ischemia–triggered Ventricular Arrhythmias by Suppressing Spinal Cord Neuronal Network Interactions in Pigs

“…Spinal or stellate ganglion blocks are being used to treat sympathetically driven ventricular arrhythmias that are resistant to conventional antiarrhythmic drug therapy, and novel spinal neuromodulation therapies are being developed to reduce cardiac arrhythmia and heart failure burden. 11,27, [43][44][45] There exists a need to understand how these sympathetically driven arrhythmias develop and how best to optimize therapies for the patients. Providing insight into the coordination and integration of neural signals in the dorsal horn and intermediolateral neurons during myocardial ischemia is critical to the understanding of the spinal cord control of cardiac pathophysiology and optimizing new pharmacologic and bioelectronic neuromodulation therapies that can be tailored to the regulation of specific network activity.…”

Modulating activity of PVN neurons prevents atrial fibrillation induced circulation dysfunction by electroacupuncture at BL15

“…Low-frequency TENS decreases sympathetic nervous system activity and increases parasympathetic nervous system activity when applied to the paravertebral ganglionar region in hypertensive patients [ 66 ] . Additionally, cervicothoracic transcutaneous electrical nerve stimulation attenuates the cardiac sympathetic overdrive in patients with heart failure [ 67 ] . Collectively, these results indicate that the abnormal activity of the sympathetic nervous system (SNS) is responsible for AF and AF-induced circulatory dysfunction.…”

Sex difference in blood pressure response to orthostatic stress: effects of transcutaneous electrical nerve stimulation

“…Cardiac output (CO), total peripheral resistance (TPR) and stroke volume (SV) were calculated using the Modelflow method (BeatScope 1.0 software, Dunedin, New Zealand Finapres Medical Systems). Conventional mode TENS (Neurodyn, Ibramed, São Paulo, Brazil) was applied by electrodes at the region of vertebral level C7 and T4 (continuous flow, symmetrical and rectangular biphasic pulse, frequency at 80 Hz and pulse duration of 150 μs) and intensity (mA) was determined as described previously [8]. The SHAM intervention (same protocol without electrical output) was initially applied for 30 min in SUP, and participants were instructed to stand up and maintain the upright position for 10 min.…”

“…During the handgrip exercise test, HF-TENS attenuated the metaboreflex activation, and vasoconstrictor and blood pressure (BP) responses in healthy young and older individuals [6], and reduced sympathetic stimulation in healthy young women [7]. Short-term cervicothoracic HF-TENS applied in patients with heart failure attenuated cardiac sympathetic overdrive [7,8].…”