Department of Physical Medicine and Rehabilitation, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH, United States of America.
J Neural Eng. 2023 Jan 18;20(1). doi: 10.1088/1741-2552/acacc9.
Although electrical vagus nerve stimulation has been shown to augment parasympathetic control of the heart, the effects of electrical conduction block have been less rigorously characterized. Previous experiments have demonstrated that direct current (DC) nerve block can be applied safely and effectively in the autonomic system, but additional information about the system dynamics need to be characterized to successfully deploy DC nerve block to clinical practice.The dynamics of the heart rate (HR) from DC nerve block of the vagus nerve were measured by stimulating the vagus nerve to lower the HR, and then applying DC block to restore normal rate. DC block achieved rapid, complete block, as well as partial block at lower amplitudes.. Complete block was also achieved using lower amplitudes, but with a slower induction time. The time for DC to induce complete block was significantly predicted by the amplitude; specifically, the amplitude expressed as a percentage of the current required for a rapid, 60 s induction time. Recovery times after the cessation of DC block could occur both instantly, and after a significant delay. Both blocking duration and injected charge were significant in predicting the delay in recovery to normal conduction.. While these data show that broad features such as induction and recovery can be described well by the DC parameters, more precise features of the HR, such as the exact path of the induction and recoveries, are still undefined. These findings show promise for control of the cardiac autonomic nervous system, with potential to expand to the sympathetic inputs as well.
尽管电刺激迷走神经已被证明可以增强心脏的副交感神经控制,但电传导阻滞的影响尚未得到严格描述。以前的实验已经证明,直流(DC)神经阻滞可以在自主神经系统中安全有效地应用,但需要进一步描述系统动力学的信息,以便成功地将 DC 神经阻滞应用于临床实践。通过刺激迷走神经来降低心率,然后施加 DC 阻断以恢复正常心率,来测量迷走神经的 DC 阻断对心率(HR)的影响。DC 阻断可以快速、完全阻断,并且在较低的幅度下也可以部分阻断。较低的幅度也可以实现完全阻断,但诱导时间较慢。DC 诱导完全阻断的时间与幅度显著相关;具体来说,幅度表示为快速、60 秒诱导时间所需电流的百分比。在 DC 阻断停止后,恢复时间可以立即发生,也可以有明显的延迟。阻断持续时间和注入电荷量都对恢复到正常传导的延迟有显著预测作用。尽管这些数据表明,像诱导和恢复这样的广泛特征可以通过 DC 参数很好地描述,但 HR 的更精确特征,如诱导和恢复的确切路径,仍然不明确。这些发现为心脏自主神经系统的控制带来了希望,也有可能扩展到交感神经输入。