Key result
Mechanical circulatory support preserves patient memory and identity, confirming cardiac signals only modulate emotional intensity.
Why the study?
Direct evidence is currently lacking on whether reduced pulsatility under mechanical circulatory support alters emotional experience, while popular claims about cardiac identity storage require critical evaluation against evidence from patients with TAHs and LVADs.
This narrative review proposes the Archive–Modulator framework, arguing that while identity and memory are stored in distributed brain networks, cardiac pulsatility and heart-to-brain signaling may modulate the intensity of emotional experience in patients on mechanical circulatory support.
Answers are grounded in this paper and cite their sources.
Cardiac signals may modulate emotion without storing identity in MCS recipients; leaves open whether altered pulsatility changes emotional intensity and requires prospective validation.
This narrative review examines why patients with total artificial hearts (TAHs) and left ventricular assist devices (LVADs) retain their memories and sense of self, and argues that identity is stored in distributed brain networks, not in the heart. It reviews the evidence on heart-to-brain communication (vagal afferents, baroreceptor pulse-phase signalling, heartbeat-evoked potentials, humoral pathways) and critically evaluates popular claims about a "heart brain" and cardiac electromagnetic entrainment. It identifies the genuinely open question: whether reduced pulsatility under mechanical circulatory support alters the intensity of emotional experience, for which direct evidence is currently lacking. It proposes the Archive–Modulator framework, with five falsifiable predictions, in which the brain stores identity and cardiac signals modulate, but are not required for, emotion. Finally, it outlines a prospective study design, including a within-patient pump-setting sub-study, to confirm or refute a modulatory role of cardiac pulsatility.
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Yasser Anwar (2026) conducted a review in Mechanical circulatory support (total artificial heart or left ventricular assist device). Mechanical circulatory support (TAH and LVAD) was evaluated on Retention of identity, memory, and emotional modulation. Total artificial hearts and LVADs preserve patient memory and identity, supporting an Archive-Modulator framework with 5 falsifiable predictions where cardiac signals only modulate emotion.
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