BACKGROUND Investigating approaches for determining a functionally meaningful dorsolateral prefrontal cortex (DLPFC) stimulation site is imperative for optimising repetitive transcranial magnetic stimulation (rTMS) response rates for treatment-resistant depression. One proposed approach is neuro-cardiac-guided rTMS (NCG-TMS) in which high frequency rTMS is applied to the DLPFC to determine the site of greatest heart rate deceleration. This site is thought to index a frontal-vagal autonomic pathway that intersects a key pathway believed to underlie rTMS response. OBJECTIVE We aimed to independently replicate previous findings of high-frequency NCG-TMS and extend it to evaluate the use of low-frequency rTMS for NCG-TMS. METHODS Twenty healthy participants (13 female; aged 38.6 ± 13.9) underwent NCG-TMS on frontal, fronto-central (active) and central (control) sites. For high-frequency NCG-TMS, three 5 s trains of 10 Hz were provided at each left hemisphere site. For low-frequency NCG-TMS, 60 s trains of 1 Hz were applied to left and right hemispheres and heart rate and heart rate variability outcome measures were analysed. RESULTS For high-frequency NCG-TMS, heart rate deceleration was observed at the left frontal compared with the central site. For low-frequency NCG-TMS, accelerated heart rate was found at the right frontal compared with central sites. No other site differences were observed. CONCLUSION Opposite patterns of heart rate activity were found for high- and low-frequency NCG-TMS. The high-frequency NCG-TMS data replicate previous findings and support further investigations on the clinical utility of NCG-TMS for optimising rTMS site localisation. Further work assessing the value of low-frequency NCG-TMS for rTMS site localisation is warranted.

中文翻译：

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研究高频和低频神经心脏引导的 TMS 以探测额叶迷走神经通路

背景研究用于确定功能上有意义的背外侧前额叶皮层 (DLPFC) 刺激部位的方法对于优化重复经颅磁刺激 (rTMS) 对难治性抑郁症的反应率是必不可少的。一种提议的方法是神经心脏引导的 rTMS (NCG-TMS)，其中将高频 rTMS 应用于 DLPFC 以确定最大心率减速的位置。该位点被认为是一个额叶迷走神经自主神经通路的索引，该通路与被认为是 rTMS 反应基础的关键通路相交。目标我们旨在独立复制先前高频 NCG-TMS 的发现，并将其扩展到评估低频 rTMS 在 NCG-TMS 中的使用。方法 20 名健康参与者（13 名女性；年龄 38.6 ± 13.9 岁）在额叶接受 NCG-TMS，fronto-central（主动）和central（控制）站点。对于高频 NCG-TMS，在每个左半球站点提供了三个 10 Hz 的 5 s 列车。对于低频 NCG-TMS，对左右半球施加 60 秒 1 Hz 的训练，并分析心率和心率变异性结果测量。结果 对于高频 NCG-TMS，与中央部位相比，左额叶的心率减慢。对于低频 NCG-TMS，与中央部位相比，右额叶的心率加快。没有观察到其他位点差异。结论 在高频和低频 NCG-TMS 中发现了相反的心率活动模式。高频 NCG-TMS 数据复制了以前的发现，并支持对 NCG-TMS 临床效用的进一步研究，以优化 rTMS 位点定位。