ArticleHuman brain mapping2019
How the insula speaks to the heart: Cardiac responses to insular stimulation in humans.
Article in Human brain mapping, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
69 citing papers in PubMed, 2 syntheses or guidelines pooled it, 135 citations in OpenAlex.
- Evidence for domain-general arousal from semantic and neuroimaging meta-analyses reconciles opposing views on arousal.Proceedings of the National Academy of Sciences of the United States of America · 2025Pooled it
- The solitary nucleus connectivity to key autonomic regions in humans.The European journal of neuroscience · 2022Pooled it
- The Impact of Alpha-Neurofeedback Training on Gastric Slow Wave Activity and Heart Rate Variability in Humans.Neurogastroenterology and motility · 2025Trial
- The insula modulates the effects of aerobic training on cardiovascular function and ambulation in multiple sclerosis.Journal of neurology · 2023Trial
- The Effects of Bi-Anodal tDCS Over the Prefrontal Cortex Regions With Extracephalic Reference Placement on Insight Levels and Cardio-Respiratory and Autonomic Functions in Schizophrenia Patients and Exploratory Biomarker Analyses for Treatment Response.The international journal of neuropsychopharmacology · 2021Trial
- Insular involvement and atrial fibrillation first detected after ischemic stroke: a systematic review and meta-analysis.Clinical autonomic research : official journal of the Clinical Autonomic Research Society · 2026Review
- Comparative insights into insula structure and function.Nature neuroscience · 2026Review
- Functional Connectivity Alterations of the Central Autonomic Network in Multiple Sclerosis: Links to Fatigue and Aerobic Training Effects.Neurology(R) neuroimmunology & neuroinflammation · 2026Article
- Distinct Brain Systems Support Afferent and Efferent Autonomic Activity.bioRxiv : the preprint server for biology · 2026Article
- Predicting neurological recovery following cardiac arrest based on dynamic brain-heart coupling.Journal of neuroengineering and rehabilitation · 2026Article
- Role of Exercise in Modulating the Brain-Heart Axis in Cardiovascular Diseases.International journal of molecular sciences · 2026Review
- A pilot study of brain correlates of long-term treatment with transcutaneous vagal nerve stimulation in posttraumatic stress disorder.Journal of affective disorders reports · 2026Article
- Distinct Subdivisions of the Cingulo-Insular Region and Their Role in Modulating the Cardiac Sympathetic-Parasympathetic Balance.Circulation. Arrhythmia and electrophysiology · 2026Observational
- Heart-Brain Axis: Subclinical Cardiovascular Changes and Brain Health.Journal of the American Heart Association · 2026Review
- Distinct brain systems support afferent and efferent autonomic activity.Social cognitive and affective neuroscience · 2026Article
- Total clinical course of left insular stroke-induced bradycardia-tachycardia and takotsubo syndrome: A case report of stroke-heart syndrome.Journal of cardiology cases · 2026Article
- Heart-brain axis pathophysiological understanding and clinical impact.Frontiers in cardiovascular medicine · 2026Review
- Central autonomic network dysfunction in Stroke-Heart Syndrome: mechanistic roles of the insula and limbic system.Frontiers in neuroscience · 2026Review
- Bidirectional brain-heart communication in coronary heart disease: from coronary plaques to central autonomic networks.Frontiers in neuroscience · 2026Review
- Neural Correlates of Restless Legs Syndrome (RLS) Based on Electroencephalogram (EEG)-A Mechanistic Review.International journal of molecular sciences · 2025Review
9 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite numerous studies suggesting the role of insular cortex in the control of autonomic activity, the exact location of cardiac motor regions remains controversial. We provide here a functional mapping of autonomic cardiac responses to intracortical stimulations of the human insula. The cardiac effects of 100 insular electrical stimulations into 47 epileptic patients were divided into tachycardia, bradycardia, and no cardiac response according to the magnitude of RR interval (RRI) reactivity. Sympathetic (low frequency, LF, and low to high frequency powers ratio, LF/HF ratio) and parasympathetic (high frequency power, HF) reactivity were studied using RRI analysis. Bradycardia was induced by 26 stimulations (26%) and tachycardia by 21 stimulations (21%). Right and left insular stimulations induced as often a bradycardia as a tachycardia. Tachycardia was accompanied by an increase in LF/HF ratio, suggesting an increase in sympathetic tone; while bradycardia seemed accompanied by an increase of parasympathetic tone reflected by an increase in HF. There was some left/right asymmetry in insular subregions where increased or decreased heart rates were produced after stimulation. However, spatial distribution of tachycardia responses predominated in the posterior insula, whereas bradycardia sites were more anterior in the median part of the insula. These findings seemed to indicate a posterior predominance of sympathetic control in the insula, whichever the side; whereas the parasympathetic control seemed more anterior. Dysfunction of these regions should be considered when modifications of cardiac activity occur during epileptic seizures and in cardiovascular diseases.
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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 OpenQuestion graph.