TMS for Sympathetic Hyperactivity and Inflammation in Acute Myocardial Infarction

Inclusion criteria

• Aged 30 to 75 years (inclusive), no restriction on sex;
• Diagnosed with acute myocardial infarction (AMI) in accordance with the Fourth Universal Definition of Myocardial Infarction (2018 ESC/ACC/AHA/WHF), with typical clinical manifestations, electrocardiographic changes and dynamic elevation of cardiac biomarkers;
• Received standardized reperfusion therapy (thrombolysis or percutaneous coronary intervention, PCI) with hemodynamic stability;
• Killip class I-II;
• Evidence of sympathetic activation: resting heart rate ≥90 beats per minute (after excluding confounders such as fever, thyroid dysfunction and severe anemia); reduced heart rate variability (e.g., SDNN <100 ms) or frequency-domain indices indicating sympathetic predominance (e.g., elevated LF/HF ratio).

Exclusion criteria

• Severe cardiac dysfunction: Killip class ≥ III, or left ventricular ejection fraction (LVEF) <30%;
• Contraindications to TMS: history of seizure, intracranial surgery or cranial trauma, intracranial/intra-cranial metallic implants, implanted pacemaker or implantable cardioverter-defibrillator;
• Active severe infection, ongoing anti-tumor treatment, or severe hepatic/renal insufficiency (judged comprehensively by clinical and laboratory findings);
• Pregnant or breastfeeding women, or those with definite pregnancy plan during the study period;
• Alcohol or substance dependence, psychiatric or cognitive disorders resulting in poor adherence;
• Participation in another interventional clinical trial within the past 3 months that may interfere with interpretation of study results;
• Prior TMS treatment for other diseases;
• Other conditions judged by investigators to make the participant unsuitable for enrollment (e.g., uncontrolled persistent myocardial ischemia, refractory arrhythmia, need for urgent cardiac surgery).