Optimal Titration Is Important to Maximize the Beneficial Effects of Vagal Nerve Stimulation in Chronic Heart Failure

JOURNAL OF CARDIAC FAILURE

卷:22

Article

Nishizaki, Akiko¹  Sakamoto, Kazuo²  Saku, Keita³  Hosokawa, Kazuya¹  Sakamoto, Takafumi¹  Oga, Yasuhiro¹  Akashi, Takuya³  Murayama, Yoshinori¹  Kishi, Takuya³  Ide, Tomomi¹  Sunagawa, Kenji³ 

[1] Kyushu Univ, Grad Sch Med Sci, Dept Cardiovasc Med, Fukuoka, Japan

[2] Saiseikai Gen Hosp, Dept Cardiovasc Med, Fukuoka, Japan

[3] Kyushu Univ, Dept Therapeut Regulat Cardiovasc Homeostasis, Ctr Disrupt Cardiovasc Med, Fukuoka, Japan

关键词: Vagal nerve stimulation;    Chronic heart failure;    Myocardial infarction;   

DOI  :  10.1016/j.cardfail.2016.04.021

来源: Elsevier

【 摘 要 】

Background: Although vagal nerve stimulation (VNS) benefits patients with chronic heart failure (CHF)., the optimal dose of VNS remains unknown. In clinical trials, adverse symptoms limited up-titration. In this study, we evaluated the impact of various voltages of VNS which were titrated below symptom threshold on cardiac function and CHF parameters in rat myocardial infarction (MI) models. Methods and Results: We randomly allocated MI rats to vagal (VNS; n = 41) and sham (Sham; n = 16) stimulation groups. We stimulated the right vagal nerve with 20 Hz at 3 different voltages for 4 weeks. We defined Max as the highest voltage that did not evoke any symptom, Half as one-half of Max, and Quarter as one-fourth of Max. All 3 VNS groups significantly reduced biventricular weight compared With Sham (P <.05). In contrast, only Half decreased left ventricular (LV) end-diastolic pressure (Half: 17.5 +/- 2.0 mm Hg; Sham: 24.2 +/- 1.2 mm Hg; P <.05) and increased LV ejection fraction (Half: 37.9 +/- 3.1%; Sham: 28.4 +/- 2.3%,-P <.05) and LV maximum +dP/dt (Half: 5918.6 +/- 2.0 mm/Hg/s; Sham: 5001.2 +/- 563.2 mm Hg/s; P <.05). The number of large vagal nerve fibers was reduced with Max (Max: 163.1 +/- 43.0 counts/bundle; Sham: 360.0 +/- 61.6 counts/bundle; P <.05), indicating significant neural damage by VNS. Conclusion: The optimal titration of VNS would maximize benefits for CHF and minimize adverse effects.

【 授权许可】

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