Electrical stimulation of the cardiac plexus allows co-activation of the sympathetic and parasympathetic systems leading to a more efficient cardiac function. Cardiac neuromodulation at this level would optimize the heart systolic and diastolic function by instantly improving cardiac output as described in our porcine model of heart failure.

We are conducting a clinical and interventional pilot study of cardiac plexus stimulation in humans to evaluate the feasibility and efficiency of this technique.

We will include 10 patients scheduled electively for coronary bypass surgery. At the end of the procedure, we will place two monopolar electrodes conventionally used in cardiac surgery at the level of the cardiac plexus nerves at destination of the left ventricle, which are located at the root of the right pulmonary artery and posterior to the trunk of the pulmonary artery.

The stimulation will be performed by a pulse generator UHS3000 (BIOTRONIK SE & Co. KG) with parameters identical to those of our experiments on porcine model (frequency of 10HzHz and intensity of 10V) for a duration of 1minute and 30seconds repeated three times.

This study has been approved by the national agency of health and drugs (ANSM) and by a research ethic committee. The inclusions starts in June 2022 in Rennes university hospital.

The primary endpoint is the variations of the cardiac output wich would be measured by an epivascular aortic probe (Medistim, MiraQ). The secondary endpoints are changes in the heart rate, aortic and pulmonary arterial pressures, central venous pressure and the occurrence of supraventricular rhythm disorders (Fig. 1).

Peripheral neuromodulation of the heart is well described in the literature for the treatment of advanced chronic heart failure. However, its use in routine practice remains limited due to low proof of their efficiency. The cardiac plexus is the regulating center of the autonomous cardiac system that controls its chronotropy and inotropy. Neuromodulation of the sympathetic and parasympathetic system at this level after heart surgery would allow increase of the cardiac output in acute heart failure states with less recourse to systemically distributed inotropes which have known arrythmogenic undesirable effects, ensuring simpler operative outcomes in heart surgery. In long term, this technique might be at the origin of several pertinent indications.