• Atsuko Seki, Hunter R Green, Thomas D Lee, LongSheng Hong, Jian Tan, Harry V Vinters, Peng-Sheng Chen, and Michael C Fishbein.
• Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: ASeki@mednet.ucla.edu.
• Heart Rhythm. 2014 Aug 1; 11 (8): 1411-7.

BackgroundVagus nerve stimulation (VNS) therapy has been used for chronic heart failure and is believed to improve imbalance of autonomic control by increasing parasympathetic activity. Although it is known that there is neural communication between the VN and the cervical sympathetic trunk, there are few data regarding the quantity and/or distribution of the sympathetic components within the vagus nerve (VN).ObjectiveTo examine the sympathetic components within the human VN and correlate them with the presence of cardiac and neurologic diseases.MethodsWe performed immunohistochemistry on 31 human cervical and thoracic VNs (total 104 VNs) from autopsies and reviewed the patients' records. We correlated the quantity of sympathetic nerve fibers within the VNs with cardiovascular and neurologic disease states.ResultsAll 104 VNs contain tyrosine hydroxylase (TH)-positive (sympathetic) nerve fibers; the mean TH-positive areas were 5.47% in the right cervical VN, 3.97% in the left cervical VN, 5.11% in the right thoracic VN, and 4.20% in the left thoracic VN. The distribution of TH-positive nerve fibers varied from case to case: central, peripheral, or scattered throughout nerve bundles. No statistically significant differences in nerve morphology were seen between diseases in which VNS is considered effective (depression and chronic heart failure) and other cardiovascular diseases or neurodegenerative disease.ConclusionHuman VNs contain sympathetic nerve fibers. The sympathetic component within the VN could play a role in physiologic effects reported with VNS. The recognition of sympathetic nerve fibers in the VNs may lead to better understanding of the therapeutic mechanisms of VNS.Copyright © 2014 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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