Drug-Free Correction of the Tone of the Autonomic Nervous System in the Management of Cardiac Arrhythmia in Coronary Artery Disease

Abstract

Background: The aim of our study was to examine the possibility of ventricular extrasystole (VES) management in CAD (coronary artery disease) patients by attenuating the sympathetic activity with a course of electrical stimulation of the vagus nerve. Methods: A decrease in sympathetic tone was achieved via vagus nerve electrical stimulation (VNES). VNES was performed in 48 male CAD patients, mean age 53.5±4.1 years. Antiarrhythmic drug therapy was canceled prior to VNES therapy. The effect of VNES on heart rate variability (HRV) and VES were carefully studied. All the patients received a 24-hour ECG monitoring. HRV was calculated for high frequency (HF) and low frequency (LF) bands and the LF/HF index was determined. Results: Immediately following VNES therapy, 30 patients (group 1) reported alleviation of angina signs and the LF/HF index was significantly decreased (p=0.001). Eighteen patients (group 2) showed no change either in health or the LF/HF index. According to ECG and echocardiography, the VES number did not significantly change immediately after VNES therapy. One month after the VNES course, group 1 reported further improvement in health; the LF/HF index approached normal values. In group 2, the LF/HF significantly decreased (p=0.043). However, in the entire study sample, the VES number significantly decreased overall (p=0.025). Conclusion: VNES attenuated the cardiac effects of hypersympathicotonia decreased the ischemic impact on the myocardium, alleviated the cardiac angina signs, and beneficially influenced the VES number in CAD patients.

Keywords

• coronary artery disease
• angina pectoris
• electric vagus nerve stimulation
• sympathetic nervous system
• ECG Holter monitoring.