Effects of early vagal nerve stimulation on cardiac functioning and damage in patients with ST-elevation myocardial infarction: A randomized controlled trial - The 72nd Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Reham Dyab ^1,2 Yori Gidron ² Stavros Stavrakis ⁴ Rani Afifi ³ Nadin Kakoush ³ Ibrahim Magdoub ³ Marwan Hijaze ³ Mahmod Hammoud ³ Elena Rivlin ³ Idit Dobrecky Mery ³

¹Quality and Safety Division, The Lady David Carmel Medical Center, Israel
²The Cheryl Spencer Department of Nursing,The Faculty of Social Welfare and Health Sciences, The University of Haifa, Israel
³Cardiology Department and Critical Care Unit, Bnai Zion Medical Center, Israel
⁴College of Medicine, The University of Oklahoma Health Sciences Center, USA

Introduction: ST-segment elevation myocardial infarction (STEMI) is a major cause of cardiovascular morbidity and mortality. Elevated sympathetic activity and inflammation may be responsible for these adverse effects. Vagus nerve stimulation (VNS) is anti-adrenergic and anti-inflammatory. Preliminary preclinical studies show that VNS decreases inflammation and infarct size.

Materials and methods:This randomized study, conducted at Bnai Zion Medical Center in collaboration with the University of Haifa, examined the effects of transcutaneous VNS (tVNS) on infarct size (Troponin), left ventricular ejection fraction (LVEF), and wall motion abnormalities. Sixty STEMI patients were randomized to receive either standard care with sham tVNS (control) or standard care with active non-invasive VNS (nVNS, experimental) following primary percutaneous coronary intervention (PCI). tVNS was administered to the auricular branch of the vagus nerve for 60 minutes. LVEF and wall motion score index (WMSI) were assessed by echocardiography at 48 hours, and troponin levels were measured at baseline, 24, and 48 hours.

Results and discussion: The mean age of patients was 60.6 years (SD = 8.7). The study included 34 (60.7%) patients with anterior/anterolateral STEMI and 12 (39.3%) had inferior STEMI. In the full sample, tVNS led to significantly greater recovery of troponin levels from 24 to 48 h than in controls, independent of sub-STEMI type. In patients with anterior STEMI, tVNS led to significantly higher LVEF (44%) than controls (37%) and to lower WMSI than controls.

These findings suggest a potential role for tVNS in improving cardiac function and reducing myocardial damage in patients with STEMI or anterior STEMI. The subgroup analysis underscores the potential benefits of tVNS in more severe STEMI cases, such as anterior infarctions. Future studies should explore the mechanisms of these effects and their long-term benefits.

Conclusions: These preliminary results suggest that tVNS may improve cardiac function and reduce myocardial damage in anterior STEMI patients.