Endovascular stimulation as a therapeutic strategy for the treatment of cardiopulmonary disorders

Endovascular electrical stimulation is a minimally invasive technique that delivers electrical impulses through the vascular system to achieve neuromodulation or neuromuscular stimulation. Compared with conventional implants, it reduces surgical risks and recovery time. This narrative review summarizes current applications in the cardiopulmonary system, focusing on cardiovascular regulation and respiratory disorder management. In cardiovascular regulation, endovascular stimulation at sites such as the superior vena cava, pulmonary arteries, coronary sinus, and inferior vena cava has been shown to modulate autonomic tone, enabling precise heart rate control, enhanced ventricular contractility, myocardial pacing, and blood pressure augmentation. Endovascular stimulation of cardiopulmonary nerves via the right pulmonary artery, has demonstrated clinical promise for treating acute decompensated heart failure. In respiratory disorders, transvenous phrenic nerve stimulation has proven effective for the management of central sleep apnea and ventilator-induced diaphragm dysfunction, achieving FDA approval following several clinical trials. Despite these advances, important challenges remain, including risks associated with wired connections, thrombus formation from basket catheters, and other device-related adverse events. Future progress is expected through advances in device miniaturization and hemocompatibility, electrode design, and long-term clinical evaluation.