Dana Shiffer, Stefano Rigo, Maura Minonzio, Deniz Timothy Yarsuvat, Eleonora Tobaldini, Ludovico Furlan, Nicola Montano, Beatrice Cairo, Alberto Porta, Antonio Roberto Zamunér, Stefanos Bonovas, Vasile Urechie, Italo Biaggioni, André Diedrich, Raffaello Furlan
{"title":"两周经皮迷走神经刺激对高肾上腺素能体位性心动过速综合征的短期和长期影响：一项概念验证试验。","authors":"Dana Shiffer, Stefano Rigo, Maura Minonzio, Deniz Timothy Yarsuvat, Eleonora Tobaldini, Ludovico Furlan, Nicola Montano, Beatrice Cairo, Alberto Porta, Antonio Roberto Zamunér, Stefanos Bonovas, Vasile Urechie, Italo Biaggioni, André Diedrich, Raffaello Furlan","doi":"10.1016/j.ejim.2025.106529","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Hyperadrenergic POTS (Hyper-POTS) is characterized by excessive central sympathetic activity and impaired cardiovagal modulation. A single transcutaneous vagus nerve stimulation (tVNS) rebalanced cardiovascular autonomic control in previous studies. Repetitive tVNS may similarly restore autonomic balance and improve symptoms in Hyper-POTS.</p><p><strong>Methods: </strong>Twenty-two Hyper-POTS were studied at baseline (Pre-tVNS), after 14 days of tVNS (tVNS), and within 24 months post-discontinuation (Post-tVNS). The modified Vanderbilt Orthostatic Symptoms Score (mVOSS) quantified symptoms. ECG, arterial pressure, respiratory activity, and muscle sympathetic nerve activity (MSNA) were continuously recorded while supine and during 75° head-up tilt (HUT). Cardiac vagal modulation (high frequency power,HF<sub>RR</sub>), sinoatrial node sympatho-vagal interaction (low-to high-frequency ratio,LF/HF), sympathetic vasomotor control (LF<sub>SAP</sub>) and arterial baroreflex sensitivity (α<sub>LF</sub>) were assessed by spectral analysis. Baroreflex sensitivity was also evaluated by spontaneous sequences (BRS) technique.</p><p><strong>Results: </strong>At tVNS, MSNA decreased in both positions. tVNS increased HF<sub>RR</sub> and decreased LF/HF in supine. During HUT, αLF increased, HF<sub>RR</sub> increased<sub>,</sub> and HR decreased compared to Pre-tVNS. Total symptom score declined in both positions, with improvements in multiple mVOSS domains during tilt. At Post-tVNS, HF<sub>RR</sub> and BRS increased in both positions. During HUT, αLF increased, HR and LF<sub>SAP</sub> decreased. MSNA returned to Pre-tVNS in both positions. Total symptom score showed sustained improvement.</p><p><strong>Conclusions: </strong>Fourteen-day tVNS enhanced cardiovagal modulation, reduced sympathetic activity, and improved orthostatic symptoms in Hyper-POTS patients. Additionally, some benefits persisted beyond the stimulation period. Thus, tVNS could potentially be used as an additional therapeutic tool in Hyper-POTS.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106529"},"PeriodicalIF":6.1000,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Short and long term effects of a two-week transcutaneous vagus nerve stimulation in hyperadrenergic postural orthostatic tachycardia syndrome: a proof-of-concept trial.\",\"authors\":\"Dana Shiffer, Stefano Rigo, Maura Minonzio, Deniz Timothy Yarsuvat, Eleonora Tobaldini, Ludovico Furlan, Nicola Montano, Beatrice Cairo, Alberto Porta, Antonio Roberto Zamunér, Stefanos Bonovas, Vasile Urechie, Italo Biaggioni, André Diedrich, Raffaello Furlan\",\"doi\":\"10.1016/j.ejim.2025.106529\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Hyperadrenergic POTS (Hyper-POTS) is characterized by excessive central sympathetic activity and impaired cardiovagal modulation. A single transcutaneous vagus nerve stimulation (tVNS) rebalanced cardiovascular autonomic control in previous studies. Repetitive tVNS may similarly restore autonomic balance and improve symptoms in Hyper-POTS.</p><p><strong>Methods: </strong>Twenty-two Hyper-POTS were studied at baseline (Pre-tVNS), after 14 days of tVNS (tVNS), and within 24 months post-discontinuation (Post-tVNS). The modified Vanderbilt Orthostatic Symptoms Score (mVOSS) quantified symptoms. ECG, arterial pressure, respiratory activity, and muscle sympathetic nerve activity (MSNA) were continuously recorded while supine and during 75° head-up tilt (HUT). Cardiac vagal modulation (high frequency power,HF<sub>RR</sub>), sinoatrial node sympatho-vagal interaction (low-to high-frequency ratio,LF/HF), sympathetic vasomotor control (LF<sub>SAP</sub>) and arterial baroreflex sensitivity (α<sub>LF</sub>) were assessed by spectral analysis. Baroreflex sensitivity was also evaluated by spontaneous sequences (BRS) technique.</p><p><strong>Results: </strong>At tVNS, MSNA decreased in both positions. tVNS increased HF<sub>RR</sub> and decreased LF/HF in supine. During HUT, αLF increased, HF<sub>RR</sub> increased<sub>,</sub> and HR decreased compared to Pre-tVNS. Total symptom score declined in both positions, with improvements in multiple mVOSS domains during tilt. At Post-tVNS, HF<sub>RR</sub> and BRS increased in both positions. During HUT, αLF increased, HR and LF<sub>SAP</sub> decreased. MSNA returned to Pre-tVNS in both positions. Total symptom score showed sustained improvement.</p><p><strong>Conclusions: </strong>Fourteen-day tVNS enhanced cardiovagal modulation, reduced sympathetic activity, and improved orthostatic symptoms in Hyper-POTS patients. Additionally, some benefits persisted beyond the stimulation period. Thus, tVNS could potentially be used as an additional therapeutic tool in Hyper-POTS.</p>\",\"PeriodicalId\":50485,\"journal\":{\"name\":\"European Journal of Internal Medicine\",\"volume\":\" \",\"pages\":\"106529\"},\"PeriodicalIF\":6.1000,\"publicationDate\":\"2025-09-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Internal Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ejim.2025.106529\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ejim.2025.106529","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Short and long term effects of a two-week transcutaneous vagus nerve stimulation in hyperadrenergic postural orthostatic tachycardia syndrome: a proof-of-concept trial.
Background and aims: Hyperadrenergic POTS (Hyper-POTS) is characterized by excessive central sympathetic activity and impaired cardiovagal modulation. A single transcutaneous vagus nerve stimulation (tVNS) rebalanced cardiovascular autonomic control in previous studies. Repetitive tVNS may similarly restore autonomic balance and improve symptoms in Hyper-POTS.
Methods: Twenty-two Hyper-POTS were studied at baseline (Pre-tVNS), after 14 days of tVNS (tVNS), and within 24 months post-discontinuation (Post-tVNS). The modified Vanderbilt Orthostatic Symptoms Score (mVOSS) quantified symptoms. ECG, arterial pressure, respiratory activity, and muscle sympathetic nerve activity (MSNA) were continuously recorded while supine and during 75° head-up tilt (HUT). Cardiac vagal modulation (high frequency power,HFRR), sinoatrial node sympatho-vagal interaction (low-to high-frequency ratio,LF/HF), sympathetic vasomotor control (LFSAP) and arterial baroreflex sensitivity (αLF) were assessed by spectral analysis. Baroreflex sensitivity was also evaluated by spontaneous sequences (BRS) technique.
Results: At tVNS, MSNA decreased in both positions. tVNS increased HFRR and decreased LF/HF in supine. During HUT, αLF increased, HFRR increased, and HR decreased compared to Pre-tVNS. Total symptom score declined in both positions, with improvements in multiple mVOSS domains during tilt. At Post-tVNS, HFRR and BRS increased in both positions. During HUT, αLF increased, HR and LFSAP decreased. MSNA returned to Pre-tVNS in both positions. Total symptom score showed sustained improvement.
Conclusions: Fourteen-day tVNS enhanced cardiovagal modulation, reduced sympathetic activity, and improved orthostatic symptoms in Hyper-POTS patients. Additionally, some benefits persisted beyond the stimulation period. Thus, tVNS could potentially be used as an additional therapeutic tool in Hyper-POTS.
期刊介绍：
The European Journal of Internal Medicine serves as the official journal of the European Federation of Internal Medicine and is the primary scientific reference for European academic and non-academic internists. It is dedicated to advancing science and practice in internal medicine across Europe. The journal publishes original articles, editorials, reviews, internal medicine flashcards, and other relevant information in the field. Both translational medicine and clinical studies are emphasized. EJIM aspires to be a leading platform for excellent clinical studies, with a focus on enhancing the quality of healthcare in European hospitals.
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