Arya Akshat V, Bisht Himanshi, Tripathi Apoorva, Agrawal Manali, Konat Ashwati, Patel Jay, Mozumder Kamalika, Shah Dhrumil, Chaturvedi Devansh, Sharma Kamal
Internal Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND.
Cureus. 2023 Jun 24;15(6):e40889. doi: 10.7759/cureus.40889. eCollection 2023 Jun.
Sympathetic imbalance coupled with impairment of baroreceptor control is a key factor responsible for hemodynamic abnormalities in congestive heart failure. Vagal nerve stimulation (VNS) and baroreceptor activation therapy (BAT) are two novel interventions for the same. In this paper, we review the role of sympathovagal alterations in cardiac diseases like heart failure, arrhythmia, hypertension (HTN), etc. Studies like neural cardiac therapy for heart failure (NECTAR-HF), autonomic regulation therapy to enhance myocardial function and reduce progression of heart failure (ANTHEM-HF), and baroreflex activation therapy for heart failure (BEAT-HF), which comprise the history, efficacy, limitations, and current protocols, were extensively analyzed in contrast to one another. Vagal nerve stimulation reverses the reflex inhibition of cardiac vagal efferent activity, which is caused as a result of sympathetic overdrive during the course for heart failure. It has shown encouraging results in certain pre-clinical studies; however, there is also a possibility of serious cardiovascular adverse events if given in higher than the recommended dosage. Attenuated baroreflex sensitivity is attributed to cardiac arrhythmogenesis during heart failure. Baroreceptor activation therapy reverses this phenomenon. However, the surgical procedure for baroreceptor stimulation can have unwarranted complications, including worsening heart failure and hypertension. Considering the effectiveness of the given modalities and taking into account the inconclusive evidence of their adverse events, more clinical trials are needed for establishing the future prospects of these interventional approaches.
交感神经失衡与压力感受器控制功能受损是导致充血性心力衰竭血流动力学异常的关键因素。迷走神经刺激(VNS)和压力感受器激活疗法(BAT)是针对这一情况的两种新型干预措施。在本文中,我们综述了交感迷走神经改变在心力衰竭、心律失常、高血压等心脏疾病中的作用。对心力衰竭的神经心脏治疗(NECTAR-HF)、增强心肌功能并减少心力衰竭进展的自主调节治疗(ANTHEM-HF)以及心力衰竭的压力反射激活治疗(BEAT-HF)等研究,从历史、疗效、局限性和当前方案等方面进行了广泛的对比分析。迷走神经刺激可逆转心力衰竭过程中由于交感神经亢进导致的心脏迷走神经传出活动的反射性抑制。在某些临床前研究中已显示出令人鼓舞的结果;然而,如果给予高于推荐剂量,也有可能发生严重的心血管不良事件。压力反射敏感性降低与心力衰竭期间的心律失常发生有关。压力感受器激活疗法可逆转这一现象。然而,压力感受器刺激的外科手术可能会出现不必要的并发症,包括心力衰竭和高血压恶化。考虑到给定治疗方式的有效性,并考虑到其不良事件的证据尚无定论,需要更多的临床试验来确定这些介入方法的未来前景。