Low-Level Tragus Stimulation for the Treatment of Ischemia and Reperfusion Injury in Patients With ST-Segment Elevation Myocardial Infarction: A Proof-of-Concept Study

• Published in: JACC. Cardiovascular interventions 2017-08, Vol.10 (15), p.1511-1520
• Main Authors: Yu, Lilei, Huang, Bing, Po, Sunny S, Tan, Tuantuan, Wang, Menglong, Zhou, Liping, Meng, Guannan, Yuan, Shenxu, Zhou, Xiaoya, Li, Xuefei, Wang, Zhuo, Wang, Songyun, Jiang, Hong
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - etiology; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - prevention & control; Biomarkers - blood; China; Creatine Kinase, MB Form - blood; Echocardiography; Electrocardiography; Female; Humans; Inflammation Mediators - blood; Male; Middle Aged; Myocardial Reperfusion Injury - diagnosis; Myocardial Reperfusion Injury - etiology; Myocardial Reperfusion Injury - physiopathology; Myocardial Reperfusion Injury - prevention & control; Myoglobin - blood; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Proof of Concept Study; Prospective Studies; Recovery of Function; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - physiopathology; ST Elevation Myocardial Infarction - therapy; Stroke Volume; Time Factors; Transcutaneous Electric Nerve Stimulation - adverse effects; Transcutaneous Electric Nerve Stimulation - methods; Treatment Outcome; Vagus Nerve Stimulation - adverse effects; Vagus Nerve Stimulation - methods; Ventricular Function, Left
• ISSN: 1876-7605
• DOI: 10.1016/j.jcin.2017.04.036

The aim of this study was to investigate whether low-level tragus stimulation (LL-TS) treatment could reduce myocardial ischemia-reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI). The authors' previous studies suggested that LL-TS could reduce the size of myocardial injury induced by ischemia. Patients who presented with STEMI within 12 h of symptom onset, treated with primary percutaneous coronary intervention, were randomized to the LL-TS group (n = 47) or the control group (with sham stimulation [n = 48]). LL-TS, 50% lower than the electric current that slowed the sinus rate, was delivered to the right tragus once the patients arrived in the catheterization room and lasted for 2 h after balloon dilatation (reperfusion). All patients were followed for 7 days. The occurrence of reperfusion-related arrhythmia, blood levels of creatine kinase-MB, myoglobin, N-terminal pro-B-type natriuretic peptide and inflammatory markers, and echocardiographic characteristics were evaluated. The incidence of reperfusion-related ventricular arrhythmia during the first 24 h was significantly attenuated by LL-TS. In addition, the area under the curve for creatine kinase-MB and myoglobin over 72 h was smaller in the LL-TS group than the control group. Furthermore, blood levels of inflammatory markers were decreased by LL-TS. Cardiac function, as demonstrated by the level of N-terminal pro-B-type natriuretic peptide, the left ventricular ejection fraction, and the wall motion index, was markedly improved by LL-TS. LL-TS reduces myocardial ischemia-reperfusion injury in patients with STEMI. This proof-of-concept study raises the possibility that this noninvasive strategy may be used to treat patients with STEMI undergoing primary percutaneous coronary intervention.