Vagal Nerve Stimulation Reduces Ventricular Arrhythmias and Mitigates Adverse Neural Cardiac Remodeling Post–Myocardial Infarction

•Vagal nerve stimulation has emerged as a promising therapeutic approach to combat the observed withdrawal of parasympathetic tone and to counteract the reflex-mediated sympathoexcitation associated with ischemic heart disease.•Reactive cVNS, delivered in a neurophysiological-guided manner, resulted in a substantial improvement in cardiac mechanical function and dramatic reduction in ventricular arrhythmias in MI + cVNS pigs compared with MI pigs.•cVNS stabilized MI-induced electrical heterogeneity in the scar-border zone, reduced anisotropic electrical propagation and conduction block, and normalized myocardial repolarization—key drivers of ventricular arrhythmias in vivo.•cVNS reduced aberrant structural remodeling of the scar-border zone and principal sympathetic efferent and afferent ganglia (stellate and T1 dorsal root ganglia).•cVNS preserved sympathetic control of the heart after MI.