Vagus Nerve Stimulation Provides Multiyear Improvements in Autonomic Function and Cardiac Electrical Stability in the ANTHEM-HF Study
Author: Bruce D Nearing1, Inderjit S Anand2, Imad Libbus3, Lorenzo A DiCarlo3, Bruce H KenKnight3, Richard L Verrier4
Affiliation:
1 Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, 99 Brookline Avenue, Boston MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA.
2 University of Minnesota Medical School, 210 Delaware Street, SE, Minneapolis MN 55455, USA.
3 LivaNova USA, 100 Cyberonics Blvd, Houston, TX 77058, USA.
4 Beth Israel Deaconess Medical Center, Division of Cardiovascular Medicine, 99 Brookline Avenue, Boston MA 02215, USA; Harvard Medical School, 25 Shattuck Street, Boston MA 02115, USA. Electronic address: rverrier@bidmc.harvard.edu.
Conference/Journal: J Card Fail
Date published: 2020 Oct 10
Other:
Special Notes: doi: 10.1016/j.cardfail.2020.10.003. , Word Count: 200
Background:
Patients with heart failure with reduced LVEF (HFrEF) experience long-term deterioration of autonomic function and cardiac electrical stability linked to increased mortality risk. ANTHEM-HF reported improved heart rate variability (HRV) and heart rate turbulence (HRT) and reduced T-wave alternans (TWA) after 12 months of vagus nerve stimulation (VNS). We investigated whether the benefits of chronic VNS persist long-term.
Methods and results:
Effects of chronic VNS on heart rate, HRV, HRT, TWA, R-wave and T-wave heterogeneity (RWH, TWH), and nonsustained ventricular tachycardia (NSVT) incidence were evaluated in all ANTHEM-HF patients with ambulatory ECG data at 24 and 36 months (n=25). Autonomic markers improved significantly at 24 months and 36 months compared to baseline (heart rate, rMSSD, SDNN, HF-HRV, HRT slope, p<0.05). Peak TWA levels remained reduced at 24 and 36 months (p<0.0001). Reductions in RWH and TWH at 6 and 12 months persisted at 24 and 36 months (p<0.01). NSVT decreased at 12, 24, and 36 months (p<0.025). No sudden cardiac deaths, ventricular fibrillation, or sustained ventricular tachycardia occurred.
Conclusion:
In symptomatic patients with HFrEF, chronic VNS appears to confer wide-ranging, persistent improvements in autonomic tone (HRV), baroreceptor sensitivity (HRT), and cardiac electrical stability (TWA, RWH, TWH).
Keywords: ECG heterogeneity; HFrEF; T-wave alternans; vagus nerve stimulation.
PMID: 33049374 DOI: 10.1016/j.cardfail.2020.10.003
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