Many studies suggest the role of the connectivity of the dorsolateral prefrontal cortex (DLPFC) and the subgenual anterior cingulate cortex (sgACC) in depression. Prior research has demonstrated that neuromodulation of either of these nodes modulates the parasympathetic activity and results in a heart rate deceleration.

A new method called "Neuro-Cardiac Guided rTMS (NCG-rTMS)" helps to adequately target the frontal-vagal network. Iseger et al.^1,2 show that the NCG-rTMS reliably locates the point of greatest heart rate deceleration at the DLPFC. Data from other research groups could also replicate this. Due to functional differences, this point is located at different positions in the individual patients. In many people it is located in the FC3/FC4 range. In this case rTMS treatment according to the 5 cm rule is recommended. In some people, however, it is localized around F3 or F4. Then the rTMS according to the BeamF3 method will probably be more effective.

The NCG-rTMS thus offers a way to find the most effective individual access to the frontal-vagal network via feedback of the heart rate.

See further research.

¹ Iseger TA et al., 2017:
Neuro-Cardiac-Guided TMS (NCG-TMS): Probing DLPFC-sgACC-vagus nerve connectivity using heart rate - First results.
(https://www.brainstimjrnl.com/article/S1935-861X(17)30793-3/abstract)

² Iseger TA et al., 2018:
Optimizing TMS Treatment for Depression Using Cardiac Response With Neuro-Cardiac-Guided-TMS (NCG TMS) (https://www.biologicalpsychiatryjournal.com/article/S0006-3223(18)30254-3/fulltext)

Iseger TA et al., 2020:
A fronto-vagal network theory for Major Depressive Disorder: Implications for optimizing neuromodulation techniques
(https://www.sciencedirect.com/science/article/pii/S1935861X19304139)

Kaur M et al., 2020
Investigating high- and low-frequency neuro-cardiac-guided TMS for probing the frontal vagal pathway
(https://www.sciencedirect.com/science/article/pii/S1935861X20300553)