TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation)

Stavrakis, Stavros; Stoner, Julie A.; Humphrey, Mary Beth; Morris, Lilah F.; Filiberti, Adrian; Reynolds, Justin C.; Elkholey, Khaled; Javed, Isma; Twidale, Nicholas; Říha, Pavel; Varahan, Subha; Scherlag, Benjamin J.; Jackman, Warren M.; Dasari, Tarun W.; Po, Sunny S.

doi:10.1016/j.jacep.2019.11.008

Cited by 164 publications

(163 citation statements)

References 39 publications

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“…In a recent clinical trial, chronic, intermittent taVNS (with the Salustim device used in this study as well) resulted in lower AF burden in about 50% of patients compared to sham control stimulation. These results support the use of taVNS to treat paroxysmal AF in selected patients (Stavrakis et al, 2020).…”

Section: The Inflammatory Reflex or Neuroinflammation In The Pathogensupporting

confidence: 78%

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

et al. 2020

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Ylikoski et al. taVNS in Tinnitus-Triggered Stress Reaction Conclusion: TRMS is an example of a stress condition in which patients may benefit from taVNS. As revealed by HRV, test-taVNS improved parasympathetic function, most efficiently in patients with a low starting HRV level. Our tinnitus treatment program, including taVNS, effectively alleviated tinnitus stress and handicap. For wider clinical use, there is a great need for more knowledge about the optimal methodology and parameters of taVNS.

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Section: The Inflammatory Reflex or Neuroinflammation In The Pathogensupporting

confidence: 78%

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

et al. 2020

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“…Zhang and Mazgalev 2011;Zhu et al 2019). Such a protective effect of VNS has been documented in post-operative patients receiving low-level VNS (Stavrakis et al 2017) and, recently, in a population of patients newly diagnosed with atrial fibrillation (Stavrakis et al 2019).…”

Section: Targeting Pulmonary Vasoconstriction and Right Ventricular Dmentioning

confidence: 88%

Pulmonary arterial hypertension: the case for a bioelectronic treatment

et al. 2019

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Pulmonary arterial hypertension (PAH) is a rare disease of unknown etiology that progresses to right ventricular failure. It has a complex pathophysiology, which involves an imbalance between vasoconstrictive and vasodilative processes in the pulmonary circulation, pulmonary vasoconstriction, vascular and right ventricular remodeling, systemic inflammation, and autonomic imbalance, with a reduced parasympathetic and increased sympathetic tone. Current pharmacological treatments for PAH include several classes of drugs that target signaling pathways in vascular biology and cardiovascular physiology, but they can have severe unwanted effects and they do not typically stop the progression of the disease. Pulmonary artery denervation has been tested clinically as a method to suppress sympathetic overactivation, however it is a nonspecific and irreversible intervention. Bioelectronic medicine, in particular vagus nerve stimulation (VNS), has been used in cardiovascular disorders like arrhythmias, heart failure and arterial hypertension and could, in principle, be tested as a treatment in PAH. VNS can produce pulmonary vasodilation and renormalize right ventricular function, via activation of pulmonary and cardiac vagal fibers. It can suppress systemic inflammation, via activation of fibers that innervate the spleen. Finally, VNS can gradually restore the balance between parasympathetic and sympathetic tone by regulating autonomic reflexes. Preclinical studies support the feasibility of using VNS in PAH. However, there are challenges with such an approach, arising from the need to affect a relatively small number of relevant vagal fibers, and the potential for unwanted cardiac and noncardiac effects of VNS in this sensitive patient population.

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“…8 PVI acts locally by electrically isolating the PVs but may also lead to spatially distributed effects by disarticulating nonlocal mechanisms such as autonomic activity driven by GPs. 9 Although there is growing evidence to support localized drivers 10,11 and autonomic mechanisms, 12 it is unclear if such mechanisms overlap 13 This study provides several pathophysiologic insights. First, AF termination by PVI did not reflect the increased complexity of AF, measured by ECGi, but did reflect the number of PDs at sites directly ablated.…”

Section: Complexity In Af Likely Reflects a Network Of Competing Mechmentioning

confidence: 90%

“…8 PVI acts locally by electrically isolating the PVs but may also lead to spatially distributed effects by disarticulating nonlocal mechanisms such as autonomic activity driven by GPs. 9 Although there is growing evidence to support localized drivers 10,11 and autonomic mechanisms, 12 it is unclear if such mechanisms overlap 13 and if eliminating such mechanisms with ablation translates to durable clinical outcomes. In this issue of the Journal, Dhillon et al 14 describe the impact of isolating the PVs on potential AF mechanisms remote from the ablated PV antra.…”

mentioning

confidence: 99%

The interconnected atrium: Acute impact of pulmonary vein isolation on remote atrial tissue

Rogers

Baykaner

Narayan

2020

Cardiovasc electrophysiol

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TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation)

Cited by 164 publications

References 39 publications

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

Stress and Tinnitus; Transcutaneous Auricular Vagal Nerve Stimulation Attenuates Tinnitus-Triggered Stress Reaction

Pulmonary arterial hypertension: the case for a bioelectronic treatment

The interconnected atrium: Acute impact of pulmonary vein isolation on remote atrial tissue

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