Vagus Nerve Stimulation in Cardiac Disease: A Systematic Review of Randomized Clinical Trials

Cardiac arrhythmias remain a major cause of morbidity and mortality, and current therapies have notable limitations. Vagus nerve stimulation (VNS), which modulates autonomic tone, has emerged as a potential adjunctive treatment. This systematic review evaluated the efficacy of invasive and noninvasive VNS in patients with atrial fibrillation, heart failure, myocardial infarction, and other rhythm disorders. A search of PubMed, Scopus, and Web of Science identified 21 randomized controlled trials, including 11,368 patients. Overall, VNS was associated with reduced atrial fibrillation incidence and burden, improved autonomic function and left ventricular ejection fraction in heart failure, and reduced arrhythmic events and infarct biomarkers after myocardial infarction. Additional benefits were observed in conditions such as vagally mediated atrioventricular block and postural orthostatic tachycardia syndrome. Across studies, VNS demonstrated a favorable safety profile. These findings suggest that VNS may be a promising multimodal strategy for reducing arrhythmia burden and improving cardiac autonomic regulation, although larger confirmatory trials are needed.