Human vagus nerve fascicular anatomy and its implications for targeted cardiac stimulation: a microCT segmentation and histological pilot anatomical study.

Introduction: The functional anatomy of autonomic nerve fascicles has remained poorly understood. Building on prior evidence of organotopic organization in the pig cervical vagus nerve, this study examined the thoracic branches of the human vagus nerve using microcomputed tomography (microCT) and histological validation. Methods: Left and right vagus nerves ( Results: Cardiac, pulmonary, and recurrent laryngeal fascicles preserved partial organization near their entry points but merged further along the nerve. In left nerves, cardiac and pulmonary fascicles merged while recurrent laryngeal fascicles remained separate; in right nerves, cardiac fascicles merged with both pulmonary and recurrent laryngeal fascicles. Right nerves had a larger diameter and contained more fascicles, with counts varying along their length, indicative of the observed anastomoses. Discussion: Notably, the superior cardiac branch on both sides remained distinct near the typical vagus nerve stimulation cuff site, highlighting potential for targeted cardiac neuromodulation potentially relevant to conditions including myocardial infarction, heart failure, and atrial fibrillation. These findings advance understanding of human vagus nerve organization and support the design of selective stimulation strategies for precise autonomic regulation.