Low Level Tragus Stimulation in Acute Decompensated Heart Failure

Not Applicable

Recruiting

• Conditions: Acute Decompensated Heart Failure
• Interventions: Device: Neuromodulation

• Registration Number: NCT02898181
• Lead Sponsor: University of Oklahoma

Brief Summary

Acute Decompensated Heart Failure (ADHF) is a major cause of morbidity and mortality. It is associated with increased systemic inflammation. Previous studies have demonstrated increased levels of cytokines such as C-reactive protein (CRP), interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-10 (IL-10) and Tumor Necrosis Factor alpha (TNFα) in patients with heart failure (HF). Increased activity of sympathetic nervous system in ADHF is linked to inflammation. Previous anti-inflammatory drug therapies in HF have demonstrated no significant impact on cardiovascular outcomes. Low-level vagus nerve stimulation (LLVNS) is a non-invasive way to modulate autonomic tone and thereby inflammation. Vagal nerve stimulation is thought to increase the parasympathetic activity and suppress the sympathetic activity. Clinical studies of vagal stimulation in chronic HF have been negative. Recent experimental and clinical data suggest that low level tragus nerve stimulation (LLTNS) may produce the same desired neuromodulator effect compared to LLVNS. It is however unknown if LLTNS in ADHF will directly lead to a reduction in the levels of pro-inflammatory cytokines (CRP, IL-1, IL-6 and TNF-α) and an increase in the level of anti-inflammatory marker IL-10. heart rate variability may also be abnormal in ADHF. The objective of this proposal is to determine the impact of LLTS on inflammatory cytokines, heart failure biomarkers(Pro BNP) and HRV in patients with ADHF.In addition we will study the impact on dyspnea resolution and change in renal function during hospitalization.

Patients will be randomized to either active or sham stimulation (2 hours daily). Serum collected will (post-admission and discharge day) will be used for cytokine measurement. We will also measure daily ECG to assess HRV and patient assessed dyspnea scale.This investigation will likely establish the first evidence of the effects of LLTS on the suppression of inflammation and improvement in dyspnea, natriuretic peptides, renal function and HRV in patients presenting with ADHF.

Detailed Description

Acute Decompensated Heart Failure (ADHF) is a major cause of morbidity and mortality. It is associated with increased systemic inflammation and poor outcomes.

Previous studies have demonstrated increased inflammation in patients with heart failure (HF). Increased activity of sympathetic nervous system in ADHF is linked to inflammation. Previous anti-inflammatory drug therapies in HF have demonstrated no significant impact on cardiovascular outcomes.

Low-level vagus nerve stimulation via stimulation of teh Tragus (LLTS) is a non-invasive way to modulate autonomic tone and thereby inflammation. Vagal nerve stimulation is thought to increase the parasympathetic activity and suppress the sympathetic activity. Recent experimental and clinical data suggest that low level tragus nerve stimulation (LLTS) may produce the same desired neuromodulator effect compared to LLVNS.

It is however unknown if LLTS in ADHF will directly lead to sympathetic tone reduction and increase in parasympathetic tone, or neuromodulation and lead to reduction in the levels of pro-inflammatory cytokines (CRP, IL-1, IL-6 and TNF-α) and an increase in the level of anti-inflammatory marker IL-10.

Autonomic tone could be assessed using heart rate variability. The objective of this proposal is to determine the impact of LLTS on inflammatory cytokines and HRV in patients with ADHF.

Patients will be randomized to either active or sham stimulation (2 hours daily).

Serum collected will (post admission and discharge day) will be used for cytokine and biomarker measurement. We will also measure 10-15 minute ECG to assess HRV. Dyspnea will be determined using patient assessment tool(visual analog scale).This investigation will likely establish the first evidence of effects of LLTS on suppression of inflammation and improvement in dyspnea scale, renal function and HRV in patients presenting with ADHF.

Study Timeline

• Study Start: 2016-09
• Study First Submitted: 2016-09-01
• Study First Submitted QC: 2016-09-07
• Study First Posted: 2016-09-13
• Status Verified: 2023-08
• Last Update Submitted: 2023-08-24
• Last Update Posted: 2023-08-29
• Primary Completion: 2024-09
• Study Completion: 2024-09

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 100

Inclusion Criteria

Patients admitted with ADHF

Exclusion Criteria

1. Refusal to consent
2. Complex congenital heart disease (Tetralogy of Fallot patients, single ventricle physiology)
3. Recurrent vaso-vagal syncopal episodes
4. Unilateral or bilateral vagotomy
5. Sick sinus syndrome
6. 2nd or 3rd degree AV block
7. bifascicular block or prolonged 1st degree AV block (PR>300ms)
8. Pregnant patients
9. Prisoners
10. Advanced renal dysfunction(defined as eGFR < 30, stage 4 or 5 chronic kidney disease)
11. Hepatitis C or HIV
12. Acute Myocardial infarction

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Tragus Stimulation	Neuromodulation	In this group patients will receive neuromodulation for 2 hours daily

Primary Outcome Measures

Name	Time	Method
Change in CRP levels	From admission to discharge- over average 3-6 days	CRP level
Change in Interleukin (IL) levels	From admission to discharge- over average 3-6 days	Interleukin level
Change in Pro BNP and renal function(creatinine) levels	From admission to discharge- over average 3-6 days	Pro BNP level
Change in TNF-alpha levels	From admission to discharge- over average 3-6 days	TNF level

Secondary Outcome Measures

Name	Time	Method
Change in HRV	From admission to discharge- over average 3-6 days	Heart rate variability measures such time and frequency domains

Trial Locations

Locations (1)

OUHSC; 🇺🇸 Oklahoma City, Oklahoma, United States