{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T12:47:57Z","timestamp":1768999677683,"version":"3.49.0"},"reference-count":30,"publisher":"American Physiological Society","issue":"2","funder":[{"DOI":"10.13039\/501100004586","name":"Funda\u00e7\u00e3o Carlos Chagas Filho de Amparo \u00e0 Pesquisa do Estado do Rio de Janeiro (FAPERJ)","doi-asserted-by":"publisher","award":["E-05\/2016"],"award-info":[{"award-number":["E-05\/2016"]}],"id":[{"id":"10.13039\/501100004586","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003593","name":"MCTI | Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico (CNPq)","doi-asserted-by":"publisher","award":["MCTI\/CNPQ\/Universal 14\/2014 - 462274\/2014-4"],"award-info":[{"award-number":["MCTI\/CNPQ\/Universal 14\/2014 - 462274\/2014-4"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["American Journal of Physiology-Heart and Circulatory Physiology"],"published-print":{"date-parts":[[2019,8,1]]},"abstract":"<jats:p> Cardiac sympathetic overdrive provides inotropic support to the failing heart. However, as myocardial insult evolves, this compensatory response impairs contractile function and constitutes an independent mortality predictor and a primary target in the treatment of heart failure (HF). In this prospective, randomized, double-blind, controlled crossover trial, we proposed cervicothoracic transcutaneous electrical nerve stimulation (CTENS) as a nonpharmacological therapy on cardiac sympathetic activity in patients with HF. Seventeen patients with HF were randomly assigned to an in-home CTENS (30 min twice daily, 80-Hz frequency, and 150-\u03bcs pulse duration) or a control intervention (Sham) for 14 consecutive days. Following a 60-day washout phase, patients were crossed over to the opposite intervention. The heart-to-mediastinum ratio (HMR) and washout rate (WR) (indexes of sympathetic innervation density and activity from planar <jats:sup>123<\/jats:sup>iodo-metaiodobenzylguanidine myocardial scintigraphy images, respectively), as well as blood pressure (BP) and heart rate (HR), were quantified before and after each intervention. HMR, BP, and HR did not change throughout the study. Nonetheless, CTENS reduced WR (CTENS \u22124\u2009\u00b1\u200910 vs. Sham +5\u2009\u00b1\u200915%, P = 0.03) when compared with Sham. When allocated in two independent groups, preserved (PCSI, HMR &gt; 1.6, n = 10) and impaired cardiac sympathetic innervation (ICSI, HRM \u22641.6, n = 7), PCSI patients showed an important attenuation of WR (\u221211\u2009\u00b1\u20099 vs. Sham +8\u2009\u00b1\u200919%, P = 0.007) after CTENS. Nonetheless, neither Sham nor CTENS evoked changes in WR of the ICSI patients ( P &gt; 0.05). These findings indicate that CTENS attenuates the cardiac sympathetic overdrive in patients with HF and a preserved innervation constitutes an essential factor for this beneficial neuromodulatory impact. Clinical Trial Registration: URL: https:\/\/www.clinicaltrials.gov . Identifier: NCT03354689. <\/jats:p><jats:p> NEW &amp; NOTEWORTHY We found that short-term cervicothoracic transcutaneous electrical nerve stimulation (CTENS) attenuates cardiac sympathetic overdrive in patients with heart failure and a preserved autonomic innervation may constitute an essential factor to maximize this beneficial neuromodulatory effect. CTENS then emerges as an alternative noninvasive and nonpharmacological strategy to attenuate exaggerated cardiac sympathetic drive in patients with heart failure. <\/jats:p>","DOI":"10.1152\/ajpheart.00091.2019","type":"journal-article","created":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T10:40:50Z","timestamp":1559299250000},"page":"H226-H233","source":"Crossref","is-referenced-by-count":5,"title":["Transcutaneous electrical nerve stimulation attenuates cardiac sympathetic drive in heart failure: a <sup>123<\/sup>MIBG myocardial scintigraphy randomized controlled trial"],"prefix":"10.1152","volume":"317","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9526-0937","authenticated-orcid":false,"given":"Monique O.","family":"Campos","sequence":"first","affiliation":[{"name":"Laboratory of Exercise Sciences, Fluminense Federal University, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3830-2886","authenticated-orcid":false,"given":"Antonio C. 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