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Low-level tragus stimulation may be beneficial in STEMI
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Low-level tragus stimulation significantly reduced myocardial ischemia and reperfusion injury in patients with STEMI undergoing primary PCI, according to data from a proof-of-concept of study.
In the prospective, single-center, open-label study, the researchers randomly assigned patients with STEMI who presented within 12 hours of symptom onset and were undergoing primary PCI to treatment with low-level tragus stimulation (n = 47) or with sham stimulation (n = 48). Stimulation was delivered to the right tragus when the patients arrived at the cath lab and lasted for 2 hours after balloon dilatation. The researchers followed patients for 7 days.
Low-level tragus stimulation was linked to significantly reduced reperfusion-related ventricular arrhythmia during the first 24 hours. Holter analysis showed that the treatment, compared with control, was associated with reductions in total number of ventricular premature beats (154 vs. 551; P < .05), isolated ventricular premature beats (133 vs. 362; P < .05), coupled premature beats (3 vs. 22; P < .05) and ventricular tachycardia (2 vs. 18; P < .05).
Furthermore, in the low-level group vs. the control group, lower areas under the curve were noted for creatine kinase-MB (5,156 ng h/mL vs. 7,646 ng h/mL; P < .05) and myoglobin level (8,632 µg h/L vs. 10,361 µg h/L; P < .05) during 72 hours after reperfusion, according to the data.
Additionally, low-level tragus stimulation reduced blood levels of N-terminal pro-B-type natriuretic peptide levels at 24 hours (905 ng/L vs. 1,595 ng/L; P < .05) and 7 days after reperfusion (548 ng/L vs. 1,127 ng/L; P < .05), as well as blood levels of inflammatory markers at 24 hours after reperfusion.
Improvements in left ventricular ejection fraction and wall motion index were also noted with low-level tragus stimulation.
“These data from this moderate-size cohort of select patients with reperfused acute [STEMI] are encouraging and confirm the benefits seen with low-level vagal nerve stimulation in the previous experimental and animal studies,” Gerd Heusch, MD, from the Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, wrote in an accompanying editorial.
Heusch noted, however, that a number of questions still remain, including whether the improvements in the surrogate endpoints observed in the study will translate to improved outcomes in clinical trials. – by Melissa Foster
Disclosures: The authors and Heusch report no relevant financial disclosures.
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