Review of Transcutaneous Vagus Nerve Stimulation as a Therapeutic Approach for the Suppression of Ventricular Premature Contractions

Premature ventricular complexes (PVCs) are among the most frequently encountered forms of cardiac arrhythmias in clinical practice.Their prognostic significance is heterogeneous and is largely determined by the underlying cardiac structure, PVC burden, complexity, and left ventricular function.Frequent or complex PVCs are linked to an elevated risk of adverse cardiovascular outcomes, whereas isolated low-burden PVCs in structurally normal hearts can be benign.Despite the substantial clinical burden imposed by PVCs, the current landscape of therapeutic options remains strikingly limited, often constrained by the adverse effects and variable efficacy of antiarrhythmic drugs, as well as the invasive nature of catheter ablation procedures.In this context, transcutaneous vagus nerve stimulation (tVNS), an innovative and non-invasive neuromodulation technique, has emerged as a promising therapeutic candidate.Through its multifaceted mechanisms of action, including the augmentation of vagal tone, the suppression of excessive sympathetic outflow, and the induction of potent anti-inflammatory effects, tVNS has demonstrated considerable potential in restoring autonomic balance.These compelling mechanistic foundations collectively suggest that tVNS may represent a plausible and novel therapeutic strategy for the effective suppression of PVCs.However, it is important to acknowledge that, while preclinical investigations and early clinical signals have yielded encouraging results, the current body of clinical evidence specifically addressing PVC suppression remains preliminary, heterogeneous, and at times contradictory.This article provides a critical narrative review of the physiological foundations and mechanistic underpinnings of tVNS, synthesizing and critically evaluating preclinical investigations and emerging preliminary clinical data.We aim to appraise the mechanistic rationale, contextualize conflicting clinical trial findings, and critically assess prospective research directions and the practical feasibility of clinical translation.