Transcutaneous Vagus Nerve Stimulation for Ventricular Arrhythmias
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: transcutaenous vagal nerve stimulation, Sham transcutaenous vagal nerve stimulation.
- Who it may be relevant to
- Registry conditions: Premature Ventricular Complexes, Ventricular Tachycardia (VT), Ventricular Arrhythmias. Basic parameters: from 18 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United Kingdom
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Transcutaneous Electrical Vagus Nerve Stimulation for Suppression of Ventricular Arrhythmias
Overview
Ventricular arrhythmias are abnormal heart rhythms that arise from the bottom chambers of the heart. They can cause debilitating symptoms when they occur intermittently (these are called premature ventricular ectopics or PVCs) and can be life-threatening when they occur continuously (called ventricular tachycardia or VT). These are the most common causes of sudden cardiac death, especially in patients with pre-existing heart disease. They can be a result of overactivation of the sympathetic nervous system, and in extreme circumstances, surgery to cut the nerve may be needed. A novel approach to target this nervous system using a transcutaneous electrical nerve stimulator (TENS) machine has successfully treated arrhythmias that come from the top chambers of the heart (atrial fibrillation). An ear clip is applied for an hour per day connected to a device (smaller than a phone) that can activate the parasympathetic nervous system (that counteracts the sympathetic nervous system). This is called Low-Level Tragus Stimulation (LLTS). Because it has been used for epilepsy for decades, we have evidence of a very high safety profile and tolerability. We plan to enrol 72 patients, 34 with many PVCs and 38 with VT, and randomise them to either first receive LLTS or first receive sham treatment (this will appear the same to the patient and researchers but without any meaningful vibrations being emitted in the sham group). Each patient will then swap over to the other treatment. We will compare whether the LLTS reduces the amount of ventricular arrhythmias during compared to the amount during the sham treatment period. We will use Holter monitors to measure the amount of PVCs after each period in the PVC group. VT patients have an implantable defibrillator that continuously monitors for VT episodes in this group. We will only enrol adults who can give informed consent, and study participation will not interfere with a patient's clinical treatment.
Interventions
- Device transcutaenous vagal nerve stimulation
Low level Stimulation of the Auricular Branch of the Vagal Nerve at the tragus - Device Sham transcutaenous vagal nerve stimulation
Sham treatment
Primary outcome measures
- VT burden [Time frame: Six months]
- PVC Burden [Time frame: 14 days]
Secondary outcome measures (3)
- 50% reduction in VT burden [Time frame: Six months]
- Change in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) Score in the Active Phase versus Sham Control Phase (VT Cohort) [Time frame: Six months]
- Change in 36-Item Short Form Survey (SF-36) Score in the Active Phase versus Sham Control Phase (PVC Cohort) [Time frame: 28 days]
Eligibility criteria
PVC Cohort
Inclusion criteria
- Age > 18 years old.
- Participants must understand and be willing to sign a written informed consent document.
- PVC burden of >10% in a 24-hour period on Holter monitoring.
Exclusion criteria
- Coronary artery disease
- Known cardiac disease (heart failure or cardiomyopathy) in the documented absence of PVCs. Individuals with suspected PVC-induced cardiomyopathy heart failure, defined as cardiomyopathy or heart failure only diagnosed in the setting of a >10% PVC burden, will be allowed to participate.
- A known diagnosis of Epilepsy.
- Ongoing pregnancy or intention to become pregnant in the forthcoming 12 months.
- Participants using a TENS device for any indication
VT cohort
Inclusion criteria
- Participants with structural heart disease and a transvenous implantable cardioverter defibrillator (ICD) in situ
- At least three clinically significant VT events (VT events defined as either >30 seconds of sustained VT, appropriate ICD ATP therapies or appropriate ICD shocks) in the six months before enrolment
Exclusion criteria
- Heart failure syndrome with inotrope dependency or requiring mechanical assistance.
- Reversible cause of arrhythmia (e.g. culprit electrolyte abnormality or toxin)
- NYHA (New York Heart Association) stage IV heart failure
- Myocardial infarction or cardiac surgery in the last six months
- Life expectancy <12 months
- Ongoing pregnancy or intention to become pregnant in the forthcoming 12 months.
- Participants using a TENS device for any indication
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Crossover
- Masking
- Quadruple blind
- Primary purpose
- Treatment
Study locations
United Kingdom · 1 center
- St Bartholomew's Hospital, Barts Health NHS Trust — London
Identifiers
NCT: NCT07026695 · 177627