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Vagus nerve stimulation: from pre-clinical to clinical application: challenges and future directions

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Abstract

Vagus nerve stimulation was performed experimentally for the first time more than 150 years ago. In the 1980s and 1990s, vagus nerve stimulation was shown, both in the anesthetized and in the conscious animal, to exert marked antiarrhythmic effects, particularly during acute myocardial ischemia. There is a strong rationale for a beneficial effect of augmented vagal activity in the setting of chronic heart failure. Studies in experimental models of heart failure showed that chronic vagus nerve stimulation exerts beneficial effects on left ventricular function and on survival. Vagus nerve stimulation is approved in man for refractory epilepsy and depression. The first-in-man study performed in 32 patients with chronic heart failure suggests that vagus nerve stimulation was safe and well tolerated. Six months of open-label treatment was associated with significant improvements (P < 0.001) in NYHA class, quality of life, 6-min walk test, LV ejection fraction (from 22 ± 7 to 29 ± 8%), and LV systolic volumes (P = 0.02). These improvements were maintained at 1 year. Mechanisms of action may include the following: heart rate, anti-adrenergic, anti-apoptotic, and anti-inflammatory effects as well as an increase in nitric oxide. Controlled clinical trials will start soon to assess whether vagus nerve stimulation can indeed represent a new non-pharmacological approach for the treatment of symptomatic heart failure.

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Authors and Affiliations

  1. Department of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Viale Golgi 19, 27100, Pavia, Italy

    Gaetano M. De Ferrari & Peter J. Schwartz

  2. Department of Lung, Blood and Heart, Section of Cardiology, University of Pavia, Pavia, Italy

    Peter J. Schwartz

  3. Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Milan, Italy

    Peter J. Schwartz

  4. Department of Medicine, Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research, University of Cape Town, Cape Town, South Africa

    Peter J. Schwartz

  5. Chair of Sudden Death, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Peter J. Schwartz

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  1. Gaetano M. De Ferrari
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Correspondence to Gaetano M. De Ferrari.

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De Ferrari, G.M., Schwartz, P.J. Vagus nerve stimulation: from pre-clinical to clinical application: challenges and future directions. Heart Fail Rev 16, 195–203 (2011). https://doi.org/10.1007/s10741-010-9216-0

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