Bursted auricular vagus nerve stimulation alters heart rate variability in healthy subjects.

Objective: Recent research suggests that percutaneous auricular vagus nerve stimulation (pVNS) beneficially modulates the autonomic nervous system (ANS). Bursted pVNS seems to be efficient for nerve excitation. Bursted pVNS effects on cardiac autonomic modulation are not disclosed yet. Approach: For the first time, the present study evaluates the effect of pVNS on cardiac autonomic modulation in healthy subjects (n=9) using two distinct bursted stimulation patterns (biphasic and triphasic stimulation) and heart rate variability analysis (HRV). Stimulation was delivered via four needle electrodes in vagally innervated regions of the right auricle. Each of the two bursted stimulation patterns was applied twice in randomized order over four consecutive stimulation sessions per subject. Main results: Bursted pVNS did not change heart rate, blood pressure, and inflammatory parameters in study subjects. pVNS significantly increased the standard deviation of heart inter-beat intervals, from 46.39±10.4 ms to 63.46±22.47 ms (p<0.05), and the total power of HRV, from 1475.7±616.13 ms² to 3190.5±2037.0 ms² (p<0.05). The high frequency (HF) power, the low frequency (LF) power, and the LF/HF ratio did not change during bursted pVNS. Both stimulation patterns did not show any significant differences in cardiac autonomic modulation. Stimulation intensity to reach a tingling sensation was significantly lower in triphasic compared to biphasic stimulation (p<0.05). Bursted stimulation was well tolerated. Significance: Bursted pVNS seems to affect cardiac autonomic modulation in healthy subjects, with no difference between biphasic and triphasic stimulation, the latter requiring lower stimulation intensities. These findings foster implementation of more efficient pVNS stimulation.