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Can Vagus Nerve Stimulation Lower Atrial Fibrillation Risk? Many complications, including blood clots, stroke, heart rhythm problems, atrial fibrillation (Afib), reduced kidney function, might emerge after heart surgery. Afib is quite common among 25 to 40 percent of postoperative patients. A study of 744 patients published September 19, 2012 in ‘Journal of Cardiothoracic Surgery’ showed that postoperative Afib was detected in 44 percent of the patients. Afib is the most common abnormal heart rhythm condition which affects more than 33.5 million individuals around the world and the number is expected to continue to rise. Afib patients have symptoms like palpitations, dizziness, shortness of breath or tightness in the chest. Patients who had an episode of Afib are more likely to develop another episode and are often kept on anticoagulant medication that raises the bleeding risk and may increase long-term complications including stroke, heart attack, heart failure. Lately, researchers from the Medical University of Vienna have developed a promising method to lower the likelihood of Afib following heart surgery. Their findings that was published October 10, 2019 in journal ‘Circulation: Arrhythmia and Electrophysiology’ revealed that the risk of Afib following surgery could be halved by delivering noninvasive low level transcutaneous electrical stimulation (LLTS) to the vagus nerve.
The LLTS device is already being used to treat
vascular occlusions, or blood clots. Noninvasive vagus nerve stimulation has
been approved in Europe for treating epilepsy, depression and pain. In the
United States, a noninvasive vagus nerve stimulation device has been permitted
to handle migraines and cluster headaches.
Vagus nerve contributes to the autonomic nervous system, a part of the nervous system that regulates involuntary bodily functions, including heart rate, digestion, respiratory rate, and sexual arousal. After surgery, the body is dealing with inflammatory reactions and oxidative stress, and the sympathetic nervous system (the body’s fight or flight response) gets activated. Roughly one third of people do not respond fully to anti-seizure drugs and nerve stimulation has become an option for these patients. Electrical stimulation of the ear and the vagus nerve that sits on the surface there has a calming effect, in that the device is stimulating largest nerve of the parasympathetic nervous system and hence the corresponding antagonists. For the study, 40 postoperative patients were divided into 2 groups of equal number: one received LLTS while the other were given a placebo. Needle electrodes were applied to the triangular fossa of the ear. Stimulation intensity was set to an amplitude of 1 mA and a frequency of 1 Hz repeatedly for 40 minutes, followed by a 20 minutes pause. The stimulation device was attached to the shoulder of the patient using an adhesive clip. Participant’s heart rhythm was recorded using a continuous ambulatory ECG during the observation period. Stimulator and electrodes remained attached to the participant for up to a maximum of 14 days. Blood samples were drawn at the time of device attachment at admission to postoperative intensive care, on day 2, and on day 7 after surgery. CRP (C-reactive protein) and IL (interleukin)-6 were measured according to routine protocols. The group of patients who received LLTS for 5 days post-surgery had a significantly lower incidence of developing Afib: 4 out of 20 patients, compared with 11 out of 20 in the control group. Since the researchers did not find a significant change in inflammatory markers between the control group and those receiving LLTS, they suggested that the treatment lowers incidences of Afib through its effect on the cardiac autonomic system rather than through modulation of post-surgical inflammation.
In an earlier study of 54 patients who had
undergone heart surgery, researchers found that vagus nerve stimulation had a
positive effect on occurrence of postoperative Afib. Instead, an invasive device
was used and implanted inside patients’ bodies. Nevertheless, this study did
indicate that a noninvasive option could make a similar positive effect with
fewer potential complications. The findings were published in September 2017 in
‘JACC: Clinical Electrophysiology’. Date: May 7, 2020
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