Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Neurology
• Medical Devices

Background:

• Heart failure (HF) with reduced ejection fraction (HFrEF) is linked to autonomic nervous system imbalance.
• Electrical abnormalities in HF can increase the risk of sudden cardiac death.
• The therapeutic role of parasympathetic stimulation via vagal nerve stimulation (VNS) in HFrEF remains incompletely understood.

Approach:

• A systematic review and meta-analysis of clinical trials published between May 1994 and July 2020.
• Searched PubMed, Embase, and Cochrane Library for studies comparing vagal nerve stimulation (VNS) with medical therapy in HFrEF patients (EF ≤ 40%).
• Assessed outcomes and adverse effects using GRADE methodology to determine the level of evidence.

Key Points:

• Included 4 RCTs and 3 prospective studies, totaling 1,263 patients (756 VNS, 507 medical therapy).
• VNS showed significant improvements in New York Heart Association (NYHA) functional class, quality of life, 6-minute walk test, and NT-proBNP levels (GRADE = High).
• Adverse effects from VNS were reported in only 11% of patients, with no significant difference in mortality observed between VNS and medical therapy groups.

Conclusions:

• High-grade evidence supports VNS as an effective treatment for improving functional capacity and quality of life in HFrEF patients.
• VNS is associated with favorable changes in cardiac biomarkers like NT-proBNP.
• While VNS does not impact mortality, it offers a promising therapeutic option for managing symptoms in chronic HFrEF.