Non-Invasive Auricular Vagus Nerve Stimulation Decreases Heart Rate Variability Independent of Caloric Load.

Abstract

The vagus nerve is crucial in regulating physiological functions, including the cardiovascular system. While heart rate (HR) and its variability (HRV) may provide non-invasive proxies of cardiac vagal activity, transcutaneous auricular vagus nerve stimulation (taVNS) has yielded mixed effects, with limited research on right branch stimulation. In a randomized crossover study with 36 healthy participants, we investigated taVNS effects on HR and HRV indexed by SDRR, RMSSD, HF-HRV, and LF/HF ratio. To assess the impact of the stimulation side (left vs. right ear) on cardiovascular indices and interaction with the physiological state, we recorded electrocardiograms in four sessions per person, covering three session phases: baseline, during stimulation (taVNS vs. sham), and post-milkshake consumption with stimulation. First, we found moderate evidence against taVNS affecting HR (BF₁₀ = 0.21). Second, taVNS decreased HRV (multivariate p = 0.004) independent of physiological state, with strong evidence for RMSSD (BF₁₀ = 15.11) and HF-HRV (BF₁₀ = 11.80). Third, taVNS-induced changes were comparable across sides and stronger than sham, indicating consistent cardiovascular effects independent of the stimulation side. We conclude that taVNS reduces HRV as indexed by RMSSD, HF-HRV, and SDRR without altering HR, contradicting the assumption that taVNS per se increases cardiovagal activity as indexed by increased HRV due to stimulating vagal afferents. Instead, our results support the role of vagal afferent activation in arousal. Crucially, taVNS on both sides can safely modulate the cardiovascular system without increasing the risk of bradycardia or causing adverse events in healthy participants, offering new treatment possibilities.