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Closed-loop control of the heart rate by electrical stimulation of the vagus nerve

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Abstract

Stimulation of the vagus nerve potentially decreases the risk of sudden cardiac death. An improvement of the technique would be its regulation using the heart rate (HR) as a feedback variable. We address the possibility of closed-loop control of the HR, focusing on the stimulation parameters, nerve fibre populations and the reproducibility of the cardiovascular response. The response to electrical stimulation of the vagus nerve was studied in seven acute experiments on pigs. Feedback regulation of the HR over periods of 5 min was carried out. Three main populations of myelinated fibres were found. The performance of the controller was significantly better at amplitudes higher than those needed for stimulation of the myelinated components only. A 18% change in the duration of the RR interval could be controlled in all experiments. The possibility of closed-loop control of the HR seems to be promising.

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Acknowledgements

The authors thank Dr Henrik Barlebo for access to the Biolab and helping to make this study possible. We also thank Ole Sørensen, Torben Madsen and Jens Sørensen, for their useful technical suggestions and help in handling the animals. This work was supported by the European Commission for the NeuralPRO Network (FP5-Program, Research and Training Network).

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Authors and Affiliations

  1. Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Fredrik Bajers 7D, 9220, Aalborg East, Denmark

    Marco Tosato, Ken Yoshida, Egon Toft & Johannes J. Struijk

  2. Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Egon Toft

  3. Department of Thoracic Surgery, Aalborg Hospital, Aarhus University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark

    Vitas Nekrasas

Authors
  1. Marco Tosato
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  2. Ken Yoshida
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  3. Egon Toft
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  4. Vitas Nekrasas
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  5. Johannes J. Struijk
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Corresponding author

Correspondence to Marco Tosato.

Additional information

Financial support: European Commission for the NeuralPRO (FP5-Program, Research and Training Network)

Appendix: VNS-control algorithm

Appendix: VNS-control algorithm

Control theory is a vast subject and it is extensively covered in most engineering educations and by many books (see e.g. [6, 22]).

A system is closed-loop controlled when at least one of its inputs depend on its output(s). Otherwise, the system is said to be in open loop. We chose to close the loop in the stimulator-vagus-heart system by continuously measuring the variable we wanted to control—the RR interval—and by feeding it back to the stimulator through a controller (Fig. 1). At each heart beat, the controller recalculates the difference between measured and target value (tracking error) and updates the input to the stimulator (the stimulation frequency) accordingly.

The proportional-integral-derivative algorithm (PID) is often a useful choice when the system to be controlled is too difficult to model, which makes the design of an optimal ad hoc controller impossible. The output of the controller is the sum of three actions (proportional, integrative and derivative), the values of which are based on the behaviour of the tracking error. When the derivative action is not used, it becomes a PI.

The proportional action deals with sudden changes in the system output. It is proportional to the tracking error.

The integrative action tries to reduce any steady tracking error. It is based on the integral of the tracking error, which is continuously computed. At any given instant, the value of this action will be proportional to the current value of the integral.

The derivative action attempts to dampen oscillations of the system output. At any given instant, the derivative is estimated by the difference between the current and the previous value of the feedback variable. Since rapid variations result in big differences between contiguous values, they will result in a strong derivative action, aimed at bringing the tracking error back to zero.

The Bang–bang or on-off strategy consists in turning the stimulation on when the tracking error is positive and turning it off when it is zero or within an accepted range.

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Tosato, M., Yoshida, K., Toft, E. et al. Closed-loop control of the heart rate by electrical stimulation of the vagus nerve. Med Bio Eng Comput 44, 161–169 (2006). https://doi.org/10.1007/s11517-006-0037-1

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