Device-based neuromodulation for cardiovascular diseases and patient' s age

Evgeny N Mikhaylov; Nigar Z Gasimova; Natalia N Belyaeva; Heber Ivan Condori Leandro; Aleksandr D Vakhrushev; Evgeny V Shlyakhto

摘要：The autonomic nervous system plays an important role in the pathogenesis of cardiovascular diseases. With aging, autonomic activity changes, and this impacts the physiological reactions to internal and external signals. Both sympathetic and parasympathetic responses seem to decline, reflecting functional and structural changes in nervous regulation. Although some investigators suggested that both the sympathetic and parasympathetic activities were suppressed, others found that only the parasympathetic activity was suppressed while the sympathetic activity increased. In addition, cardiac innervation progress-ively diminishes with aging. Therefore, one may suggest that neuromodulation interventions may have different effects, and older age groups can express an attenuated response. This article aims to discuss the effect of device-based neuromodulation in different cardiovascular diseases, depending on the patient's age. Thus, we cover renal denervation, pulmonary artery denerva-tion, baroreceptor activation therapy, vagus nerve stimulation, spinal cord stimulation, ganglionated plexi ablation for the man-agement of arterial and pulmonary hypertension, heart failure, angina and arrhythmias. The results of many clinical studies ap-peared to be unconvincing. In view of the low rate of positive findings in clinical studies incorporating neuromodulation ap-proaches, we suggest the underestimation of advanced age as a potential contributing factor to poorer response. Analysis of out-comes between different age groups in clinical trials may shed more light on the true effects of neuromodulation when neutral/ambiguous results are obtained.