Objective: To characterize the effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on cardiac autonomic regulation at rest and during paced deep breathing in advanced Parkinson’s disease (PD), accounting for dopaminergic medication status and microlesion effects.

Background: Autonomic dysfunction is a prevalent non-motor feature of PD and contributes to increased morbidity and mortality. Heart rate variability (HRV) offers a non-invasive assessment of cardiac autonomic modulation, yet the impact of STN-DBS on dynamic autonomic control remains unclear.

Method: Nine patients with advanced PD undergoing bilateral STN-DBS were prospectively studied. HRV was assessed at rest and during paced deep breathing (6 breaths/min) preoperatively in dopaminergic ON and OFF states, early postoperatively with stimulation OFF (microlesion phase), and 3-4 weeks after DBS programming in both medication states. Time- and frequency-domain HRV parameters were analyzed using the Wilcoxon signed-rank test for all variables, and paired t-tests were additionally applied for normally distributed variables.

Results: In the post-DBS DRUG-OFF state, STN-DBS did not alter resting HRV but increased low frequency (LF) power (nu), low frequency/high frequency (LF/HF) ratio, and heart rate (HR) during deep breathing, indicating LF-dominant autonomic oscillations. In contrast, in the post-DBS DRUG-ON state, STN-DBS was associated with higher HR at rest and during deep breathing and reduced root mean square of successive differences (RMSSD), standard deviation of NN intervals (SDNN), and LF power (ms2) during deep breathing, suggesting impaired cardiovagal and baroreflex-related modulation. Dopaminergic medication pre-DBS reduced HF power (nu) during deep breathing, and no significant microlesion effects were observed.

Conclusion: Bilateral STN-DBS in advanced PD predominantly modulates dynamic cardiac autonomic responsiveness during autonomic challenge, with effects that differ across dopaminergic states, underscoring the importance of medication status in autonomic assessment after stimulation.

Baseline characteristics of the study participants

Comparison of HRV pre-DBS and post-DBS(DRUG OFF)

Comparison of HRV pre-DBS and post-DBS(DRUG ON)

Effect of dopaminergic medication on HRV

Microlesion changes in HRV following DBS

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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-subthalamic-nucleus-deep-brain-stimulation-on-heart-rate-variability-in-parkinsons-disease/