Balancing the autonomic scale: the promise of transcutaneous vagus nerve stimulation in combating cardiovascular diseases.

INTRODUCTION: Cardiovascular diseases (CVD) remain a significant burden on global health, often associated with autonomic nervous system (ANS) dysfunction, particularly prolonged sympathetic hyperactivity. Transcutaneous vagus nerve stimulation (tVNS) offers a non-invasive method for modulating vagal tone to achieve autonomic balance, presenting a potentially promising therapeutic approach for hypertension, heart failure and arrhythmia that requires further validation. METHODS: This review elucidates the mechanistic foundations of tVNS and examines its evolving application in the management of cardiovascular diseases. We also critically evaluate current challenges, including the preliminary nature of the evidence, the predominance of surrogate endpoints, and the need for adequately powered multicentre trials to determine whether tVNS can deliver meaningful clinical benefit. RESULTS: Preliminary evidence suggests that tVNS may modulate heart rate variability, enhance baroreflex sensitivity, and reduce inflammatory markers, although these effects have been demonstrated primarily in small-scale or short-term studies. Available safety data indicate that tVNS is generally well tolerated in the short term, with most reported adverse effects being mild and transient. However, challenges remain in optimizing stimulation parameters, assessing long-term efficacy, and developing personalized treatment protocols. DISCUSSION: However, it must be emphasized that no major cardiovascular guideline currently recommends tVNS for routine clinical use, and the evidence base remains investigational.