Nelson Vergel
Founder, ExcelMale.com
Low-level tragus stimulation (LLTS) is a non-invasive neuromodulation technique that has shown promising results in treating various cardiovascular conditions. Here are the key points about LLTS:
## Mechanism of Action
LLTS works by stimulating the auricular branch of the vagus nerve (ABVN) located in the tragus of the ear[1]. This stimulation:
- Activates afferent vagal nerve fibers that transmit signals to the brainstem
- Modulates autonomic function by altering the balance between sympathetic and parasympathetic activity
- Triggers peripheral vascular protection through the cholinergic anti-inflammatory pathway
## Applications in Cardiovascular Diseases
LLTS has demonstrated potential benefits in several cardiovascular conditions:
### Atrial Fibrillation (AF)
- Reduces AF burden and duration of induced AF episodes[1][5]
- Decreases AF inducibility and reverses acute atrial electrical remodeling[1]
- Lowers levels of inflammatory markers like TNF-alpha and C-reactive protein[1]
### Myocardial Infarction (MI) and Ischemia
- Attenuates ischemia-reperfusion injury[4]
- Reduces infarct size and improves left ventricular function[1][4]
- Decreases inflammatory responses and oxidative stress[2]
### Heart Failure
- Improves diastolic parameters in heart failure with preserved ejection fraction (HFpEF)[1]
- Reduces systemic inflammation and oxidative stress in acute decompensated heart failure[2]
## Stimulation Parameters
While parameters may vary between studies, common LLTS settings include:
- Frequency: 20 Hz
- Pulse width: 200-500 μs
- Amplitude: Below the threshold of discomfort, typically 1-2 mA[1][2]
- Duration: Varies from acute (1-hour sessions) to chronic (daily sessions for months)[1][5]
## Advantages
LLTS offers several benefits compared to invasive vagus nerve stimulation:
- Non-invasive and well-tolerated by patients
- Fewer complications and side effects
- Can be easily applied in outpatient settings
## Clinical Evidence
Multiple clinical studies have demonstrated the efficacy of LLTS:
- A randomized clinical trial (TREAT AF) showed an 85% decrease in AF burden with chronic LLTS over 6 months[5]
- Pilot studies in patients with paroxysmal AF, HFpEF, and acute MI have yielded promising results[1]
While LLTS shows great potential, larger clinical trials are needed to fully establish its efficacy and optimal treatment protocols for various cardiovascular conditions.
Sources
[1] Non-invasive Low-level Tragus Stimulation in Cardiovascular ... - NCBI Non-invasive Low-level Tragus Stimulation in Cardiovascular Diseases
[2] Noninvasive low-level tragus stimulation attenuates inflammation ... Noninvasive low-level tragus stimulation attenuates inflammation and oxidative stress in acute heart failure
[3] Non-invasive Low-level Tragus Stimulation | AER Journal Non-invasive Low-level Tragus Stimulation in Cardiovascular Diseases
[4] Low-Level Tragus Stimulation for the Treatment of Ischemia and ... 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
[5] TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to ... TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Clinical Trial
[6] Low-Level Transcutaneous Electrical Vagus Nerve Stimulation ... Low-Level Transcutaneous Electrical Vagus Nerve Stimulation Suppresses Atrial Fibrillation
[7] Low‐Level Tragus Stimulation Modulates Atrial Alternans and ... https://www.ahajournals.org/doi/10.1161/JAHA.120.020865
