Carandina Angelica, Rodrigues Gabriel Dias, Di Francesco Pietro, Filtz Annalisa, Bellocchi Chiara, Furlan Ludovico, Carugo Stefano, Montano Nicola, Tobaldini Eleonora
Department of Internal Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Brazil; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Auton Neurosci. 2021 Dec;236:102893. doi: 10.1016/j.autneu.2021.102893. Epub 2021 Oct 9.
Autonomic nervous system (ANS) dysfunction is a well-known feature of cardiovascular diseases (CVDs). Studies on heart rate variability (HRV), a non-invasive method useful in investigating the status of cardiovascular autonomic control, have shown that a predominance of sympathetic modulation not only contributes to the progression of CVDs but has a pivotal role in their onset. Current therapies focus more on inhibition of sympathetic activity, but the presence of drug-resistant conditions and the invasiveness of some surgical procedures are an obstacle to complete therapeutic success. On the other hand, targeting the parasympathetic branch of the autonomic nervous system through invasive vagus nerve stimulation (VNS) has shown interesting results as alternative therapeutic approach for CVDs. However, the invasiveness and cost of the surgical procedure limit the clinical applicability of VNS and hinder the research on the physiological pathway involved. Transcutaneous stimulation of the auricular branch of the vagus nerve (tVNS) seems to represent an important non-invasive alternative with effects comparable to those of VNS with surgical implant. Thus, in the present narrative review, we illustrate the main studies on tVNS performed in healthy subjects and in three key examples of CVDs, namely heart failure, hypertension and atrial fibrillation, highlighting the neuromodulatory effects of this technique.
自主神经系统（ANS）功能障碍是心血管疾病（CVD）的一个众所周知的特征。心率变异性（HRV）研究是一种用于研究心血管自主控制状态的非侵入性方法，该研究表明，交感神经调制占主导不仅会促进心血管疾病的进展，而且在其发病过程中起关键作用。目前的治疗更多地侧重于抑制交感神经活动，但耐药情况的存在以及一些外科手术的侵入性是实现完全治疗成功的障碍。另一方面，通过侵入性迷走神经刺激（VNS）靶向自主神经系统的副交感神经分支已显示出有趣的结果，可作为心血管疾病的替代治疗方法。然而，手术过程的侵入性和成本限制了VNS的临床应用，并阻碍了对所涉及生理途径的研究。经皮刺激迷走神经耳支（tVNS）似乎是一种重要的非侵入性替代方法，其效果与手术植入的VNS相当。因此，在本叙述性综述中，我们阐述了在健康受试者以及心力衰竭、高血压和心房颤动这三种关键心血管疾病实例中进行的关于tVNS的主要研究，突出了该技术的神经调节作用。
