Cardiac responses of vagus nerve stimulation: intraoperative bradycardia and subsequent chronic stimulation

Clin Neurol Neurosurg. 2007 Dec;109(10):849-52. doi: 10.1016/j.clineuro.2007.07.024. Epub 2007 Sep 6.


Objectives: Few adverse events on heart rate have been reported with vagus nerve stimulation (VNS) for refractory epilepsy. We describe three cases with intraoperative bradycardia during device testing.

Patients and methods: At our hospital 111 patients have received a VNS system. Intraoperative device testing is performed under ECG-monitoring. We reviewed the patients and their VNS-therapy follow-up outcome who experienced a change in heart rate, during device testing (Lead Test).

Results: Three patients with medically refractory epilepsy showed a bradycardia during intraoperative Lead Test. Postoperative the VNS-therapy started under ECG-monitoring. No change in cardiac rhythm occurred. Subsequent chronic stimulation is uneventful. All three have reduced seizure frequency. Two already have had their second implant, without the occurrence of bradycardia.

Conclusion: In case of intraoperative bradycardia VNS-therapy onset should be done under ECG-monitoring. Subsequent chronic stimulation is safe in respect to heart rate. Bradycardia during intraoperative device testing is no reason to abort the operation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bradycardia / physiopathology*
  • Electric Stimulation Therapy / instrumentation*
  • Electrocardiography
  • Electrocardiography, Ambulatory
  • Electrodes, Implanted
  • Epilepsies, Partial / physiopathology
  • Epilepsies, Partial / surgery*
  • Epilepsy, Complex Partial / physiopathology
  • Epilepsy, Complex Partial / surgery*
  • Epilepsy, Tonic-Clonic / physiopathology
  • Epilepsy, Tonic-Clonic / surgery*
  • Female
  • Follow-Up Studies
  • Heart Block / physiopathology
  • Humans
  • Intraoperative Complications / physiopathology*
  • Intraoperative Complications / therapy
  • Male
  • Middle Aged
  • Monitoring, Intraoperative
  • Postoperative Complications / physiopathology
  • Prostheses and Implants*
  • Remission, Spontaneous
  • Vagus Nerve / physiopathology*
  • Vocal Cord Paralysis / physiopathology