Trial reportJACC. Clinical electrophysiology2020
TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Clinical Trial.
Trial report in JACC. Clinical electrophysiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 6 registered trials, which are not on this map. Cited by 148 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
TRanscutaneous Electrical vAgus Nerve sTimulation to Suppress Atrial Fibrillation
Transcutaneous (Tragus) Vagal Nerve Stimulation (tVNS) for Post-op Atrial Fibrillation (POAF)
The Effectiveness of Transcutaneous Electrical Nerve Stimulation of the Auricular Branch of the Vagus Nerve in Loss Weight and Improving the Quality of Life in Patients With Obesity
Non-invasive Vagus Nerve Stimulation in Patients Undergoing Electrophysiological Study (VNS-EPS)
Effects of Transcutaneous Auricular Vagus Nerve Stimulation on Ventricular Rate Control in Patients With Persistent Atrial Fibrillation
Sustained Auricular Nerve Stimulation for PVC Suppression
Who cites it
148 citing papers in PubMed, 7 syntheses or guidelines pooled it, 226 citations in OpenAlex.
- The efficacy of transcutaneous vagus nerve stimulation in heart failure management - a systematic review and meta-analysis.BMC cardiovascular disorders · 2025Pooled it
- Pulmonary vein isolation plus adjunctive therapy for the treatment of atrial fibrillation: a systematic review and meta-analysis.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2024Pooled it
- Cardiovascular effects of auricular stimulation -a systematic review and meta-analysis of randomized controlled clinical trials.Frontiers in neuroscience · 2023Pooled it
- Auricular Vagus Neuromodulation-A Systematic Review on Quality of Evidence and Clinical Effects.Frontiers in neuroscience · 2021Pooled it
- Vagal Neuromodulation in Chronic Heart Failure With Reduced Ejection Fraction: A Systematic Review and Meta-Analysis.Frontiers in cardiovascular medicine · 2021Pooled it
- Psychological aspects of atrial fibrillation: A systematic narrative review : Impact on incidence, cognition, prognosis, and symptom perception.Current cardiology reports · 2020Pooled it
- Omega-3 and Risk of atrial fibrillation: Vagally-mediated double-edged sword.Progress in cardiovascular diseasesPooled it
- Transauricular Vagus Nerve Stimulation in Acute Ischaemic Stroke Requiring Mechanical Thrombectomy: Sham-Controlled, Randomised Device Trial.Translational stroke research · 2025Trial
- Tragus Nerve Stimulation Attenuates Postural Orthostatic Tachycardia Syndrome in Post COVID-19 Infection.Clinical cardiology · 2025Trial
- Acute right-sided transcutaneous vagus nerve stimulation improves cardio-vagal baroreflex gain in patients with chronic heart failure.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2025Trial
- Low-Level Tragus Stimulation Attenuates Blood Pressure in Young Individuals With Hypertension: Results From a Small-Scale Single-Blind Controlled Randomized Clinical Trial.Journal of the American Heart Association · 2024Trial
- Noninvasive Vagus Nerve Stimulation in Postural Tachycardia Syndrome: A Randomized Clinical Trial.JACC. Clinical electrophysiology · 2024Trial
- Noninvasive low-level tragus stimulation attenuates inflammation and oxidative stress in acute heart failure.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2023Trial
- Auricular Vagal Neuromodulation and its Application in Patients with Heart Failure and Reduced Ejection Fraction.Arquivos brasileiros de cardiologia · 2023Trial
- Neuromodulation of Inflammation to Treat Heart Failure With Preserved Ejection Fraction: A Pilot Randomized Clinical Trial.Journal of the American Heart Association · 2022Trial
- Ameliorating effects and mechanisms of transcutaneous auricular vagal nerve stimulation on abdominal pain and constipation.JCI insight · 2021Trial
- Low-Level Tragus Stimulation Modulates Atrial Alternans and Fibrillation Burden in Patients With Paroxysmal Atrial Fibrillation.Journal of the American Heart Association · 2021Trial
- Effects of Low-Level Tragus Stimulation on Endothelial Function in Heart Failure With Reduced Ejection Fraction.Journal of cardiac failure · 2021Trial
- Hypertension: a missing piece in HFpEF?Hypertension research : official journal of the Japanese Society of Hypertension · 2026Review
- Vagal Nerve Stimulation for Cardiovascular Diseases: From Hype to Hope.Circulation · 2026Article
88 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
15 authors at 1 institution in 1 country.
Funding
Abstract
objectivesThis study was a sham-controlled, double-blind, randomized clinical trial to examine the effect of chronic low level tragus stimulation (LLTS) in patients with paroxysmal AF.
backgroundLow-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve at the tragus (LLTS) acutely suppresses atrial fibrillation (AF) in humans, but the chronic effect remains unknown.
methodsLLTS (20 Hz, 1 mA below the discomfort threshold) was delivered using an ear clip attached to the tragus (active arm) (n = 26) or the ear lobe (sham control arm) (n = 27) for 1 h daily over 6 months. AF burden over 2-week periods was assessed by noninvasive continuous electrocardiogram monitoring at baseline, 3 months, and 6 months. Five-minute electrocardiography and serum were obtained at each visit to measure heart rate variability and inflammatory cytokines, respectively.
resultsBaseline characteristics were balanced between the 2 groups. Adherence to the stimulation protocol (≤4 sessions lost per month) was 75% in the active arm and 83% in the control arm (p > 0.05). At 6 months, the median AF burden was 85% lower in the active arm compared with the control arm (ratio of medians: 0.15; 95% confidence interval: 0.03 to 0.65; p = 0.011). Tumor necrosis factor-alpha was significantly decreased by 23% in the active group relative to the control group (ratio of medians: 0.77; 95% confidence interval: 0.63 to 0.94; p = 0.0093). Frequency domain indices of heart rate variability were significantly altered with active versus control stimulation (p < 0.01). No device-related side effects were observed.
conclusionsChronic, intermittent LLTS resulted in lower AF burden than did sham control stimulation, supporting its use to treat paroxysmal AF in selected patients. (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation [TREAT-AF]; NCT02548754).
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.