Repetitive transcranial magnetic stimulation improves cardiovascular autonomic nervous system control: A meta-analysis

Hanall Lee; Joon Ho Lee; Moon-Hyon Hwang; Nyeonju Kang

doi:10.1016/j.jad.2023.07.039

Repetitive transcranial magnetic stimulation improves cardiovascular autonomic nervous system control: A meta-analysis

J Affect Disord. 2023 Oct 15:339:443-453. doi: 10.1016/j.jad.2023.07.039. Epub 2023 Jul 17.

Authors

Hanall Lee¹, Joon Ho Lee², Moon-Hyon Hwang³, Nyeonju Kang⁴

Affiliations

¹ Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea. Electronic address: hlee2500@inu.ac.kr.
² Department of Human Movement Science, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea. Electronic address: ljhgo7@inu.ac.kr.
³ Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Health & Kinesiology, Incheon National University, Incheon, South Korea. Electronic address: mhwang@inu.ac.kr.
⁴ Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Sport Science, Sport Science Institute & Health Promotion Center, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea. Electronic address: nyunju@inu.ac.kr.

PMID: 37459970
DOI: 10.1016/j.jad.2023.07.039

Abstract

Background: Cardiovascular autonomic system (ANS) may be affected by altered neural activations in the brain. This systematic review and meta-analysis investigated potential effects of repetitive transcranial magnetic stimulation (rTMS) protocols on cardiovascular ANS control.

Methods: Through 19 qualified studies, we acquired 70 comparisons for data synthesis. Individual effect sizes were estimated by comparing changes in following cardiovascular ANS control variables between active and sham stimulation conditions: (a) blood pressure (BP), (b) heart rate (HR), and (c) heart rate variability (HRV). Moreover, two moderator variable analyses determined whether changes in cardiovascular ANS control were different based on (a) rTMS protocols (excitatory rTMS versus inhibitory rTMS) and (b) specific targeted cortical regions, respectively.

Results: The random-effects model meta-analysis revealed significant improvements in cardiovascular ANS control after the rTMS protocols. Specifically, applying excitatory and inhibitory rTMS protocols significantly decreased values of BP and HR variables. For HRV variables, excitatory rTMS protocols showed significant positive effects. These improvements in cardiovascular ANS control were observed while applying either excitatory rTMS protocols to the left dorsolateral prefrontal cortex or inhibitory rTMS protocols to the right dorsolateral prefrontal cortex.

Limitations: Relatively small number of studies for inhibitory rTMS on the right dorsolateral prefrontal cortex were included in this meta-analysis.

Conclusion: These findings suggest that applying excitatory and inhibitory rTMS protocols on prefrontal cortical regions may be effective to improve cardiovascular ANS control.

Keywords: Autonomic nervous system; Cardiac responses; Dorsolateral prefrontal cortex; Repetitive transcranial magnetic stimulation.

Publication types

Review