title: Cardiac responses of vagus nerve stimulation: intraoperative bradycardia and subsequent chronic stimulation.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Medisch Spectum Twente, Enschede, The Netherlands. j.ardesch@ziekenhuis-mst.nl
authors.forename: J J
authors.initials: JJ
authors.lastname: Ardesch
authors.forename: H P J
authors.initials: HP
authors.lastname: Buschman
authors.forename: P H
authors.initials: PH
authors.lastname: van der Burgh
authors.forename: L J J C
authors.initials: LJ
authors.lastname: Wagener-Schimmel
authors.forename: H E
authors.initials: HE
authors.lastname: van der Aa
authors.forename: G
authors.initials: G
authors.lastname: Hageman
mesh_terms: D000328:Adult; D001919:Bradycardia / Q000503:physiopathology*; D004599:Electric Stimulation Therapy / Q000295:instrumentation*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004567:Electrodes, Implanted; D004828:Epilepsies, Partial / Q000503:physiopathology / Q000601:surgery*; D017029:Epilepsy, Complex Partial / Q000503:physiopathology / Q000601:surgery*; D004830:Epilepsy, Tonic-Clonic / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000503:physiopathology; D019736:Prostheses and Implants; D012075:Remission, Spontaneous; D014630:Vagus Nerve / Q000503:physiopathology*; D014826:Vocal Cord Paralysis / Q000503:physiopathology