Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Ventricular Ectopy!

Transcutaneous electrical vagus nerve stimulation to suppress premature ventricular complexes is a novel non-invasive therapy which has been evaluated in two recent clinical trials. Low-level electrical stimulation of the tragus is done using a transcutaneous device. It is being considered as a bridge therapy for those who have moderate PVC burdens (10–15%) but aren’t yet ready for invasive catheter ablation.

NoVa-PVC trial studied antiadrenergic effects of low-level electrical stimulation of the tragus in reducing the burden of ventricular ectopy. Of the 36 patients randomized, 35 completed the study protocol. They were symptomatic patients with at least 5% daily PVC burden who were refractory to medical therapy. 10-day sessions of low-level electrical stimulation of the tragus (20 Hz, 1mA below the discomfort threshold) and sham stimulation (ear lobe stimulation) were the comparisons. Each treatment was followed by an 8-day washout period before crossover to the other protocol. All patients were wearing extended Holter monitoring patch to check daily PVC count during the study period. LLTS significantly reduced the median PVC burden by 13.4% compared with sham stimulation.

TREAT PVC trial was multi-center, double-blind, randomized controlled trial of patients with PVC burden > 10% randomly assigned to the active or sham LLTS in 1:1 fashion for 6 months. 48 patients in each group completed the study protocol. 33% relative risk reduction was noted in the active treatment group. Interestingly there was 27% relative risk reduction the sham group, indicating a strong placebo effect. The data was presented at the Late-Breaking Clinical Trials session of Heart Rhythm Society meeting 2025. May be a better sham control method is needed as patients can easily recognize difference between stimulation of the tragus and earlobe. Larger number of patients may need to be studied as well.