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Kronsteiner B, Carrero-Rojas G, Reissig LF, Moghaddam AS, Schwendt KM, Gerges S, Maierhofer U, Aszmann OC, Pastor AM, Kiss A, Podesser BK, Birkfellner W, Moscato F, Blumer R, Weninger WJ. Characterization, number, and spatial organization of nerve fibers in the human cervical vagus nerve and its superior cardiac branch. Brain Stimul 2024; 17:510-524. [PMID: 38677543 DOI: 10.1016/j.brs.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Electrical stimulation of the vagus nerve (VN) is a therapy for epilepsy, obesity, depression, and heart diseases. However, whole nerve stimulation leads to side effects. We examined the neuroanatomy of the mid-cervical segment of the human VN and its superior cardiac branch to gain insight into the side effects of VN stimulation and aid in developing targeted stimulation strategies. METHODS Nerve specimens were harvested from eight human body donors, then subjected to immunofluorescence and semiautomated quantification to determine the signature, quantity, and spatial distribution of different axonal categories. RESULTS The right and left cervical VN (cVN) contained a total of 25,489 ± 2781 and 23,286 ± 3164 fibers, respectively. Two-thirds of the fibers were unmyelinated and one-third were myelinated. About three-quarters of the fibers in the right and left cVN were sensory (73.9 ± 7.5 % versus 72.4 ± 5.6 %), while 13.2 ± 1.8 % versus 13.3 ± 3.0 % were special visceromotor and parasympathetic, and 13 ± 5.9 % versus 14.3 ± 4.0 % were sympathetic. Special visceromotor and parasympathetic fibers formed clusters. The superior cardiac branches comprised parasympathetic, vagal sensory, and sympathetic fibers with the left cardiac branch containing more sympathetic fibers than the right (62.7 ± 5.4 % versus 19.8 ± 13.3 %), and 50 % of the left branch contained sensory and sympathetic fibers only. CONCLUSION The study indicates that selective stimulation of vagal sensory and motor fibers is possible. However, it also highlights the potential risk of activating sympathetic fibers in the superior cardiac branch, especially on the left side.
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Affiliation(s)
- Bettina Kronsteiner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Genova Carrero-Rojas
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Lukas F Reissig
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Atieh Seyedian Moghaddam
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Karoline M Schwendt
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Sylvia Gerges
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria; Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Angel M Pastor
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, 41012, Sevilla, Spain
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Center for Biomedical Research and Translational Surgery, Medical University of Vienna, Austria
| | - Wolfgang Birkfellner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria; Austrian Cluster for Tissue Regeneration, Vienna, Austria
| | - Roland Blumer
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria.
| | - Wolfgang J Weninger
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
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Kronsteiner B, Haberbusch M, Aigner P, Kramer AM, Pilz PM, Podesser BK, Kiss A, Moscato F. A novel ex-vivo isolated rabbit heart preparation to explore the cardiac effects of cervical and cardiac vagus nerve stimulation. Sci Rep 2023; 13:4214. [PMID: 36918673 PMCID: PMC10014867 DOI: 10.1038/s41598-023-31135-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
The cardiac responses to vagus nerve stimulation (VNS) are still not fully understood, partly due to uncontrollable confounders in the in-vivo experimental condition. Therefore, an ex-vivo Langendorff-perfused rabbit heart with intact vagal innervation is proposed to study VNS in absence of cofounding anesthetic or autonomic influences. The feasibility to evoke chronotropic responses through electrical stimulation ex-vivo was studied in innervated isolated rabbit hearts (n = 6). The general nerve excitability was assessed through the ability to evoke a heart rate (HR) reduction of at least 5 bpm (physiological threshold). The excitability was quantified as the charge needed for a 10-bpm HR reduction. The results were compared to a series of in-vivo experiments rabbits (n = 5). In the ex-vivo isolated heart, the baseline HR was about 20 bpm lower than in-vivo (158 ± 11 bpm vs 181 ± 19 bpm). Overall, the nerve remained excitable for about 5 h ex-vivo. The charges required to reduce HR by 5 bpm were 9 ± 6 µC and 549 ± 370 µC, ex-vivo and in-vivo, respectively. The charges needed for a 10-bpm HR reduction, normalized to the physiological threshold were 1.78 ± 0.8 and 1.22 ± 0.1, in-vivo and ex-vivo, respectively. Overall, the viability of this ex-vivo model to study the acute cardiac effects of VNS was demonstrated.
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Affiliation(s)
- Bettina Kronsteiner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria.
| | - Max Haberbusch
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Philipp Aigner
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Anne-Margarethe Kramer
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Patrick M Pilz
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Bruno K Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Francesco Moscato
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
- Austrian Cluster for Tissue Engineering, Vienna, Austria
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Agnesi F, Zinno C, Strauss I, Dushpanova A, Casieri V, Bernini F, Terlizzi D, Gabisonia K, Lionetti V, Micera S. Cardiovascular Response to Intraneural Right Vagus Nerve Stimulation in Adult Minipig. Neuromodulation 2023:S1094-7159(23)00131-9. [PMID: 36997453 DOI: 10.1016/j.neurom.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE This study explored intraneural stimulation of the right thoracic vagus nerve (VN) in sexually mature male minipigs to modulate safe heart rate and blood pressure response. MATERIAL AND METHODS We employed an intraneural electrode designed for the VN of pigs to perform VN stimulation (VNS). This was delivered using different numbers of contacts on the electrode and different stimulation parameters (amplitude, frequency, and pulse width), identifying the most suitable stimulation configuration. All the parameter ranges had been selected from a computational cardiovascular system model. RESULTS Clinically relevant responses were observed when stimulating with low current intensities and relatively low frequencies delivered with a single contact. Selecting a biphasic, charge-balanced square wave for VNS with a current amplitude of 500 μA, frequency of 10 Hz, and pulse width of 200 μs, we obtained heart rate reduction of 7.67 ± 5.19 beats per minute, systolic pressure reduction of 5.75 ± 2.59 mmHg, and diastolic pressure reduction of 3.39 ± 1.44 mmHg. CONCLUSION Heart rate modulation was obtained without inducing any observable adverse effects, underlining the high selectivity of the intraneural approach.
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Affiliation(s)
- Filippo Agnesi
- BioRobotics Institute, Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ciro Zinno
- BioRobotics Institute, Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ivo Strauss
- Institut für Mikrosystemtechnik, University of Frieberg, IMTEK, Freiburg, Germany
| | - Anar Dushpanova
- Unit of Translational Critical Care Medicine, Laboratory of Basic and Applied Medical Sciences, Interdisciplinary Research Center "Health Science," Scuola Superiore Sant'Anna, Pisa, Italy; Health Research Institute, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Valentina Casieri
- Unit of Translational Critical Care Medicine, Laboratory of Basic and Applied Medical Sciences, Interdisciplinary Research Center "Health Science," Scuola Superiore Sant'Anna, Pisa, Italy; BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | | | - Vincenzo Lionetti
- Unit of Translational Critical Care Medicine, Laboratory of Basic and Applied Medical Sciences, Interdisciplinary Research Center "Health Science," Scuola Superiore Sant'Anna, Pisa, Italy; BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvestro Micera
- BioRobotics Institute, Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy; Bertarelli Foundation Chair in Translational NeuroEngineering, Centre for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
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Huffman WJ, Musselman ED, Pelot NA, Grill WM. Measuring and modeling the effects of vagus nerve stimulation on heart rate and laryngeal muscles. Bioelectron Med 2023; 9:3. [PMID: 36797733 PMCID: PMC9936668 DOI: 10.1186/s42234-023-00107-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Reduced heart rate (HR) during vagus nerve stimulation (VNS) is associated with therapy for heart failure, but stimulation frequency and amplitude are limited by patient tolerance. An understanding of physiological responses to parameter adjustments would allow differential control of therapeutic and side effects. To investigate selective modulation of the physiological responses to VNS, we quantified the effects and interactions of parameter selection on two physiological outcomes: one related to therapy (reduced HR) and one related to side effects (laryngeal muscle EMG). METHODS We applied a broad range of stimulation parameters (mean pulse rates (MPR), intra-burst frequencies, and amplitudes) to the vagus nerve of anesthetized mice. We leveraged the in vivo recordings to parameterize and validate computational models of HR and laryngeal muscle activity across amplitudes and temporal patterns of VNS. We constructed a finite element model of excitation of fibers within the mouse cervical vagus nerve. RESULTS HR decreased with increased amplitude, increased MPR, and decreased intra-burst frequency. EMG increased with increased MPR. Preferential HR effects over laryngeal EMG effects required combined adjustments of amplitude and MPR. The model of HR responses highlighted contributions of ganglionic filtering to VNS-evoked changes in HR at high stimulation frequencies. Overlap in activation thresholds between small and large modeled fibers was consistent with the overlap in dynamic ranges of related physiological measures (HR and EMG). CONCLUSION The present study provides insights into physiological responses to VNS required for informed parameter adjustment to modulate selectively therapeutic effects and side effects.
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Affiliation(s)
- William J. Huffman
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Eric D. Musselman
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Nicole A. Pelot
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA
| | - Warren M. Grill
- grid.26009.3d0000 0004 1936 7961Department of Biomedical Engineering, Duke University, Fitzpatrick CIEMAS, Box 90281, Room 1427, 101 Science Drive, Durham, NC 27708-0281 USA ,grid.26009.3d0000 0004 1936 7961Department of Electrical and Computer Engineering, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Neurobiology Engineering, Duke University, Durham, USA ,grid.26009.3d0000 0004 1936 7961Department of Neurosurgery Engineering, Duke University, Durham, USA
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Haberbusch M, Kronsteiner B, Kramer AM, Kiss A, Podesser BK, Moscato F. Closed-loop vagus nerve stimulation for heart rate control evaluated in the Langendorff-perfused rabbit heart. Sci Rep 2022; 12:18794. [PMID: 36335207 PMCID: PMC9637096 DOI: 10.1038/s41598-022-23407-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022] Open
Abstract
Persistent sinus tachycardia substantially increases the risk of cardiac death. Vagus nerve stimulation (VNS) is known to reduce the heart rate, and hence may be a non-pharmacological alternative for the management of persistent sinus tachycardia. To precisely regulate the heart rate using VNS, closed-loop control strategies are needed. Therefore, in this work, we developed two closed-loop VNS strategies using an in-silico model of the cardiovascular system. Both strategies employ a proportional-integral controller that operates on the current amplitude. While one control strategy continuously delivers stimulation pulses to the vagus nerve, the other applies bursts of stimuli in synchronization with the cardiac cycle. Both were evaluated in Langendorff-perfused rabbit hearts (n = 6) with intact vagal innervation. The controller performance was quantified by rise time (Tr), steady-state error (SSE), and percentual overshoot amplitude (%OS). In the ex-vivo setting, the cardiac-synchronized variant resulted in Tr = 10.7 ± 4.5 s, SSE = 12.7 ± 9.9 bpm and %OS = 5.1 ± 3.6% while continuous stimulation led to Tr = 10.2 ± 5.6 s, SSE = 10 ± 6.7 bpm and %OS = 3.2 ± 1.9%. Overall, both strategies produced a satisfying and reproducible performance, highlighting their potential use in persistent sinus tachycardia.
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Affiliation(s)
- Max Haberbusch
- grid.22937.3d0000 0000 9259 8492Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria ,grid.454395.aLudwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria
| | - Bettina Kronsteiner
- grid.22937.3d0000 0000 9259 8492Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria ,grid.454395.aLudwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Anne-Margarethe Kramer
- grid.22937.3d0000 0000 9259 8492Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Attila Kiss
- grid.454395.aLudwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Center for Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Bruno K. Podesser
- grid.454395.aLudwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria ,grid.22937.3d0000 0000 9259 8492Center for Biomedical Research, Medical University of Vienna, Vienna, Austria ,Ludwig Boltzmann Cluster for Tissue Regeneration, Vienna, Austria
| | - Francesco Moscato
- grid.22937.3d0000 0000 9259 8492Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria ,grid.454395.aLudwig Boltzmann Institute for Cardiovascular Research, Vienna, Austria ,Ludwig Boltzmann Cluster for Tissue Regeneration, Vienna, Austria
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Haberbusch M, Frullini S, Moscato F. Corrections to "A Numerical Model of the Acute Cardiac Effects Provoked by Cervical Vagus Nerve Stimulation". IEEE Trans Biomed Eng 2022; 69:3275. [PMID: 36121966 DOI: 10.1109/tbme.2022.3200296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In the above paper [1] there are minor errors in several equations, which we correct here. There is also an error in Fig. 5, which we also correct here.
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