Can we Modulate the Autonomic Nervous System to Improve the Life of Patients with Heart Failure? The Case of Vagal Stimulation

An imbalance of the autonomic nervous system, with reduced vagal and increased sympathetic activity, contributes to pathogenesis and clinical deterioration in heart failure (HF). Experimental studies have demonstrated that vagal stimulation (VS) has an antifibrillatory effect that has proved beneficial in animal models of HF. The potential value of chronic VS in man was first investigated with an implantable neuro-stimulator capable of delivering low current pulses with adjustable parameters to stimulate the right vagus. The results of a pilot study and a small multicentre clinical trial of VS in HF patients appeared to show a favourable clinical effect, and feasibility and safety data were encouraging. An ongoing pivotal clinical trial will provide a definitive assessment of the efficacy and usefulness of chronic VS in HF patients.This approach represents a new and exciting possibility for the management of HF that will provide clinicians with a novel tool to modulate non-pharmacologically the autonomic nervous system in patients with moderate-to-advanced HF.