Theta-burst stimulation and prefrontal regulation of cardiovascular autonomic outputs: the role of state anxiety

T. Poppa Fioretti, S. de Witte, M. Vanderhasselt, A. Bechara, C. Baeken

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Cortical regions including the prefrontal and insular cortices may be involved in tonic regulation of cardiovascular autonomic outflows. Yet, the neurophysiological mechanisms of how the cortex exerts this top-down control remains unclear. Transcranial magnetic stimulation (TMS) may be a promising approach to assess functional relationships between the cortex and visceromotor effectors. However, there is inconsistent evidence as to whether TMS applied to the cortex can alter cardiovascular autonomic states. This inconsistency may partly be explained by participant state anxiety with respect to the stimulation procedures- an issue which has not received attention in TMS studies of neurocardiac interactions. To this aim, we evaluated the effects of intermittent and continuous theta-burst stimulation (TBS) to the right ventrolateral prefrontal cortex on cardiovascular responses in 24 healthy adults in a sham-controlled, within-subjects study. We additionally measured state anxiety in response to stimulation. State anxiety significantly increased for both intermittent and continuous TBS relative to sham. Intermittent TBS also significantly increased heart-rate variability at natural and slow-paced breathing rates. However, these effects were suppressed after accounting for stimulation-induced anxiety. This suggests that cardiac vagal reactivity may reflect a response to a transient stressor (i.e., the stimulation itself), rather than TBS effects on visceromotor networks. Yet, continuous TBS significantly increased pulse transit time latency, an effect that was enhanced after accounting for state anxiety. While TMS may be able to alter fronto-limbic interactions related to cardiovascular autonomic regulation, additional studies are still required. The results here emphasize that future non-invasive brain stimulation studies of neurocardiac interactions should account for participants' acute stress responses to the stimulation procedures per se. Keywords: heart rate variability, pulse transit time, cardiovascular, theta burst stimulation
Originele taal-2English
Pagina's (van-tot)510-510
Aantal pagina's1
TijdschriftBrain Stimulation
Volume12
Nummer van het tijdschrift2
DOI's
StatusPublished - 1 mrt 2019

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