Gentile Francesco, Giannoni Alberto, Navari Alessandro, Degl'Innocenti Eleonora, Emdin Michele, Passino Claudio
Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33 (56127), Pisa, Italy.
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
Clin Auton Res. 2025 Feb;35(1):75-85. doi: 10.1007/s10286-024-01074-9. Epub 2024 Oct 14.
The aim of this paper is to investigate the acute effects of short-term transcutaneous vagus nerve stimulation (tVNS) on cardio-vagal baroreflex gain and heart rate variability in patients with chronic heart failure (CHF).
A total of 16 adults with CHF and left ventricular ejection fraction (LVEF) < 50% in sinus rhythm were enrolled (65 ± 8 years, 63% men, LVEF 40 ± 5%, 88% on beta-blockers, 50% on quadruple CHF therapy). Over a single experimental session, after a 10-min baseline recording, each patient underwent two trials of 10-min tVNS (Parasym Device, 200 µs, 30 Hz, 1 mA below discomfort threshold) at either the right or left tragus in a randomized order, separated by a 10-min recovery.
Compared with baseline, tVNS did not affect heart rate, blood pressure, and respiratory rate (p > 0.05), and no patients complained of discomfort or any adverse effect. Right-sided tVNS was associated with a significant increase in cardio-vagal baroreflex gain (from 5.6 ± 3.1 to 7.5 ± 3.8 ms/mmHg, ∆ 1.9 ± 1.6 ms/mmHg, p < 0.001), while no change was observed with left-sided tVNS (∆ 0.5 ± 2.0 ms/mmHg, p = 0.914). These findings were independent of stimulation-side order (excluding any carry-over effect) and consistent across sex, LVEF category, and HF etiology subgroups (p-value for interaction > 0.05).
Acute right-sided tVNS increases cardio-vagal baroreflex gain in patients with CHF and LVEF < 50%, with no tolerability concerns.
本文旨在研究短期经皮迷走神经刺激（tVNS）对慢性心力衰竭（CHF）患者心迷走压力反射增益和心率变异性的急性影响。
共纳入16例窦性心律的CHF成年患者，左心室射血分数（LVEF）<50%（年龄65±8岁，男性占63%，LVEF为40±5%，88%服用β受体阻滞剂，50%接受四联CHF治疗）。在单次实验过程中，经过10分钟的基线记录后，每位患者以随机顺序在右或左耳屏进行两次10分钟的tVNS试验（Parasym设备，200微秒，30赫兹，1毫安，低于不适阈值），两次试验之间间隔10分钟的恢复时间。
与基线相比，tVNS对心率、血压和呼吸频率无影响（p>0.05），且无患者抱怨不适或任何不良反应。右侧tVNS与心迷走压力反射增益显著增加相关（从5.6±3.1增加到7.5±3.8毫秒/毫米汞柱，变化量为1.9±1.6毫秒/毫米汞柱，p<0.001），而左侧tVNS未观察到变化（变化量为0.5±2.0毫秒/毫米汞柱，p=0.914）。这些发现与刺激侧顺序无关（排除任何遗留效应），且在性别、LVEF类别和HF病因亚组中一致（交互作用p值>0.05）。
急性右侧tVNS可增加LVEF<50%的CHF患者的心迷走压力反射增益，且不存在耐受性问题。
