Low-level vagus nerve stimulation during cardiac surgery: smart neuromodulation

Abstract

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): CVON-AFFIP Dutch Heart Foundation Objective The goal of this study is to unravel the anti-arrhythmogenic effects of low-level vagus nerve stimulation (LL-VNS) by performing high-resolution and high-density epicardial mapping studies before and after transcutaneous LL-VNS in patients undergoing primary cardiac surgery. Background Vagus nerve stimulation has pro-arrhythmogenic and anti-arrhythmogenic properties. LL-VNS has been proven to reduce AF incidence and burden, but the anti-arrhythmogenic effect of LL-VNS remains largely unexplored thereby hampering clinical implementation and optimal patient selection. Methods 10 patients (90% male, age 75±6 years) undergoing coronary artery bypass surgery (CABG) were included in this study. Epicardial sinus rhythm mapping of the right atrium and Bachmann’s bundle (BB) was performed prior, after acute- and chronic transcutaneous LL-VNS. Results LL-VNS did not result in any significant changes in potential fractionation, conduction block, conduction velocity or voltage. Potential duration prolonged from 37.5 [31.0-56.0] ms to 48 [36.0-50.0] ms during acute (p=0.002) and 52.5 [45.8-61.0] ms during chronic LL-VNS (p=0.007). Conclusions This is the first epicardial mapping study in humans investigating the effect of LL-VNS on atrial conduction. Compared to no LL-VNS, acute and chronic LL-VNS prolonged potential duration significantly.