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Noninvasive Tragus (Ear) Neurostimulation as a New Therapy

J Card Fail 2020 Dec 30;S1071-9164(20)31589

Effects of low-level tragus stimulation on endothelial function in heart failure with reduced ejection fraction

Tarun W Dasari 1, Tamas Csipo 2, Faris Amil 3, Agnes Lipecz 2, Gabor A Fulop 2, Yunqiu Jiang 4, Rajesh Samannan 3, Sarah Johnston 5, Yan D Zhao 5, Federico Silva-Palacios 3, Stavros Stavrakis 6, Andriy Yabluchanskiy 2, Sunny S Po 6

· Cardiovascular Section, Department of Internal Medicine, University of Oklahoma Health Sciences Center, OK; Heart Rhythm Institute, University of Oklahoma Health Sciences Center, OK. Electronic address:


Background: Autonomic dysregulation in HFrEF plays a major role in endothelial dysfuction. Low level Tragus stimulation (LLTS) is a novel, non-invasive method of autonomic modulation.

Methods: We enrolled 50 HFrEF patients (LVEF≤40%) in a randomized, double-blinded, crossover study. Day 1: patients underwent 60 minutes of LLTS with a transcutaneous stimulator (20Hz, 200 μs pulse width) or sham (ear lobule) stimulation. Macrovascular function was assessed using flow mediated dilatation (FMD) in brachial artery and cutaneous microcirculation with laser speckle contrast imaging in hand and nail bed. Day 2: patients were crossed over to other study arm and underwent sham or LLTS; vascular tests were repeated pre- and post-stimulation.

Results: Compared to sham, LLTS improved FMD by increasing the %-change in brachial artery diameter (5 to 7.5, LLTS on day 1, p=0.02; 4.9 to 7.1, LLTS on day 2, p= 0.003), compared to no significant change in the sham group (4.6 to 4.7, p=0.84 on day 1 and 5.6 to 5.9, p=0.65 on day 2). Cutaneous microcirculation in hand showed no improvement and perfusion of nail bed showed a trend towards improvement.

Conclusion: Our study demonstrated beneficial effects of acute neuromodulation on macrovascular function. Larger studies to validate these findings and understand mechanistic links are warranted.

Keywords: endothelial dysfunction; heart failure with reduced ejection fraction; low-level tragus stimulation; non-invasive neuromodulation.

Copyright © 2020. Published by Elsevier Inc.

Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest.

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