Data Driven Control of Vagus Nerve Stimulation for the Cardiac System

Abstract

1Vagus nerve stimulation is an emerging therapy that seeks to offset pathological conditions by electrically stimulating the vagus nerve through cuff electrodes, where an electrical pulse is defined by several parameters such as pulse amplitude, pulse width, and pulse frequency. This electroceutical therapy has been approved for epilepsy, and treatment resistant depression. Currently, vagus nerve stimulation is under investigation for the treatment of heart failure, heart arrhythmia, hypertension, and gastric motility disorders. Through several clinical trials that sought to assess vagus nerve stimulation for the treatment of heart failure, stimulation parameters were determined heuristically and the results were left inconclusive, which has led to the suggestion of using a closed-loop approach to optimize the stimulation parameters. A recent investigation has demonstrated highly specific control of cardiac physiology by selectively activating different fibers in the vagus nerve. When multiple locations and multiple stimulation parameters are considered for optimization, the design of closed-loop control becomes considerably more challenging. To address this challenge, we investigated a data-driven control scheme for both modeling and controlling the rat cardiac system. Using an existing in silico physiological model of a rat heart to generate synthetic input-output data, we trained a long short-term memory network (LSTM) to map the effect of stimulation on the heart rate and the blood pressure. The trained LSTM was utilized in a model predictive control framework to optimize the vagus nerve stimulation parameters for set point tracking of the heart rate and the blood pressure in closed-loop simulations. Additionally, we altered the underlying in silico physiological model to consider intra-patient variability, and diseased dynamics from increased sympathetic tone in designing closed-loop VNS strategies. Throughout the different simulation scenarios, we leveraged the design of the controller to demonstrate alternative clinical objectives. Our results show the controller can optimize stimulation parameters to achieve set-point tracking with nominal offset while remaining computationally efficient. Furthermore, we show a controller formulation that compensates for mismatch due to intra-patient variabilty, and diseased dynamics. This study demonstrates the first application and a proof-of-concept for using a purely data-driven approach for the optimization of vagus nerve stimulation parameters in closed-loop control of the cardiac system.