Veterans Affairs

Improved vagus nerve stimulation treatment for heart failure

Electrode design and placement minimizes the negative side effects common to this treatment

Medical & Biotechnology

Medical researchers at the Department of Veterans Affairs have invented a novel vagus nerve stimulation treatment for patients with heart failure. The patent-pending procedure and device are available for license to companies that would make, use, or sell it commercially.

The research leading to the technology focused on congestive heart failure (CHF), which is characterized by a sustained decrease in the heart’s pumping ability usually due to ventricular contractile dysfunction. CHF results in decreased blood delivery to the body and an accumulation of blood on the venous side of the circulatory system. CHF also causes drops in vagal and parasympathetic activities.

The vagus nerve is part of the automatic nervous system that controls involuntary bodily functions, including heart rate. Thus, vagal nerve stimulation has proven to be an effective treatment for heart failure with a number of positive outcomes, including improvements in patients who are able to sustain greater levels and extent of physical activities, such as walking.

A vagal nerve stimulation procedure is typically performed by applying electrical stimulation to the portion of the vagus nerve that traverses the neck region. This area is a common stimulation site because the human vagus nerve tends to be more accessible for electrical stimulation by conventional electrodes in that particular region. This avoids a riskier surgical procedure and can be performed under local anesthesia. However, vagal nerve stimulation in the neck can also cause negative side effects such as transient hoarseness, coughing, and discomfort. Consequently, the duration of each continuous stimulation period is limited.

The VA researchers are countering the negative side effects by stimulating cardiac branches of the vagus nerve below the laryngeal nerve bifurcation, an area of the vagus nerve located in the right upper chest. Stimulating the vagus nerve here results in parasympathetic activation without disturbing nearby sympathetic nerve fibers or triggering adverse sympathetic responses (e.g., increased heart rate).

The procedure utilizes open field electrodes, a small plate electrode, epimysial electrode, fascial electrode, needle electrode, and a securable-wire electrode, which are less invasive than cuff electrodes.

The device and procedure are beneficial for patients with heart failure or those undergoing open heart surgery, a period when vagal parasympathetic effects on the heart are reduced.

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