De Ferrari Gaetano M, Dusi Veronica
G Ital Cardiol (Rome). 2015 Mar;16(3):147-54. doi: 10.1714/1820.19822.
In the last two decades, the autonomic imbalance characterized by vagal withdrawal and sympathetic increase has been shown to play a major role in the progression and prognosis of heart failure. Therefore, modulation of the autonomic nervous system (neuromodulation) with the aim to restore autonomic balance is gaining increasing interest as a potential therapy for patients with heart failure. Recently, different non-pharmacological approaches to neuromodulation have been evaluated in phase II and III clinical trials. Electrical vagus nerve stimulation is the most studied. This technique showed excellent results in preclinical studies, but at present the clinical experience is limited to a few studies, the results of which are apparently conflicting.This review discusses the preclinical and clinical experience of vagal stimulation in heart failure, in order to help understand the complexity of the methodology and our still limited knowledge of the dose-response relationship, which make difficult to interpret and compare the results of studies conducted with different designs and evaluating different devices and stimulation protocols.
在过去二十年中，以迷走神经张力减退和交感神经张力增加为特征的自主神经失衡已被证明在心力衰竭的进展和预后中起主要作用。因此，旨在恢复自主神经平衡的自主神经系统调制（神经调制）作为心力衰竭患者的一种潜在治疗方法正越来越受到关注。最近，不同的非药物神经调制方法已在II期和III期临床试验中进行了评估。电迷走神经刺激是研究最多的。该技术在临床前研究中显示出优异的结果，但目前临床经验仅限于少数研究，其结果显然相互矛盾。本综述讨论了迷走神经刺激在心力衰竭中的临床前和临床经验，以帮助理解该方法的复杂性以及我们对剂量反应关系仍有限的认识，这使得难以解释和比较采用不同设计并评估不同设备和刺激方案的研究所得到的结果。
