Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Heart & Vascular Institute, Henry Ford Hospital, Detroit, MI 48202, USA.
Cleve Clin J Med. 2011 Aug;78 Suppl 1(0 1):S24-9. doi: 10.3949/ccjm.78.s1.04.
Autonomic dysregulation is a feature of chronic heart failure (HF) and is characterized by a sustained increase of sympathetic drive and by withdrawal of parasympathetic activity. Both sympathetic overdrive and increased heart rate are predictors of poor long-term outcome in patients with HF. Pharmacologic agents that partially inhibit sympathetic activity, such as beta-adrenergic receptor blockers, effectively reduce mortality and morbidity in patients with chronic HF. In contrast, modulation of parasympathetic activation as a potential therapy for HF has received only limited attention because of its inherent complex cardiovascular effects. This review examines results of experimental animal studies that provide support for the possible use of electrical vagus nerve stimulation (VNS) as a long-term therapy for the treatment of chronic HF. The review also addresses the effects of VNS on potential modifiers of the HF state, including proinflammatory cytokines, nitric oxide elaboration, and myocardial expression of gap junction proteins. Finally, the safety, feasibility, and efficacy trends of VNS in patients with advanced HF are reviewed.
自主神经调节障碍是慢性心力衰竭（HF）的特征，表现为交感神经驱动持续增加和副交感神经活动减弱。交感神经过度兴奋和心率增加都是 HF 患者预后不良的预测因素。部分抑制交感神经活性的药物，如β肾上腺素能受体阻滞剂，可有效降低慢性 HF 患者的死亡率和发病率。相比之下，由于其固有的复杂心血管效应，副交感神经激活的调节作为 HF 的潜在治疗方法仅受到有限关注。本文综述了实验动物研究的结果，这些结果为电迷走神经刺激（VNS）作为慢性 HF 长期治疗的可能用途提供了支持。本文还讨论了 VNS 对 HF 状态潜在修饰因子的影响，包括促炎细胞因子、一氧化氮的产生以及缝隙连接蛋白在心肌中的表达。最后，还综述了 VNS 在晚期 HF 患者中的安全性、可行性和疗效趋势。
