Baroreflex Activation Therapy in Congestive Heart Failure: Novel Findings and Future Insights

Abstract

Congestive heart failure is characterized by hemodynamic and non-hemodynamic abnormalities, the latter including an activation of the sympathetic influences to the heart and peripheral circulation coupled with an impairment of baroreceptor control of autonomic function. Evidence has been provided that both these alterations are hallmark features of the disease with a specific relevance for the disease progression as well as for the development of life-threatening cardiac arrhythmias. In addition, a number of studies have documented in heart failure the adverse prognostic role of the sympathetic and baroreflex alterations, which both are regarded as major independent determinants of cardiovascular morbidity and mortality. This represents the pathophysiological and clinical background for the use of carotid baroreceptor activation therapy in the treatment of congestive heart failure. Promising data collected in experimental animal models of heart failure have supported the recent performance of pilot small-scale clinical studies, aimed at providing initial information in this area. The results of these studies demonstrated the clinical safety and efficacy of the intervention which has been tested in large-scale clinical studies. The present paper will critically review the background and main results of the published studies designed at defining the clinical impact of baroreflex activation therapy in congestive heart failure patients. Emphasis will be given to the strengths and limitations of such studies, which represent the background for the ongoing clinical trials testing the long-term effects of the device in heart failure patients.

CE: Guideline-Directed Cardiac Devices for Patients with Heart Failure

“…As with other implanted devices, the baroreflex activation stimulator has potential complications of infection or bleeding. Additionally, because of parasympathetic stimulation, patients may experience hypotension and/or syncope, although these effects have been reported rarely 31…”

“…Additionally, because of parasympathetic stimulation, patients may experience hypotension and/or syncope, although these effects have been reported rarely. 31 Percutaneously inserted pulmonary artery pressure monitor. Approved by the FDA in 2014, 32 this heart failure device recently seen in clinical practice is not used for therapy, but for remote diagnostic monitoring.…”

The Scientific Targets: the Myocardium, the Vasculature and the Body’s Response to Heart Failure

“…The area of autonomic imbalance and deranged reflex control is currently under intensive investigation, both within the context of establishing reliable and accurate diagnostic methods which would allow us to translate sophisticated pathophysiology into simplified clinical implications, and also in the context of an identification of crucial targets for therapeutic interventions (both pharmacological agents and with implantable devices). Among the therapeutic approaches under investigations are the modulation of baroreflexes via carotid baroreceptor stimulation [32,33], carotid body ablation, renal sympathetic nerve ablation [34], vagal nerve stimulation [35], the activation of systemic cholinergic signalling (acetylocholinesterase inhibitors), and many more.…”

Papel dos quimiorreceptores carotídeos nas respostas hemodinâmicas e respiratórias à estimulação elétrica do seio carotídeo/nervo do seio carotídeo

“…A técnica pioneira de ESC em ratos acordados, desenvolvida no presente estudo, deu origem a um primeiro conjunto de dados, os quais foram publicados na revista científica Hypertension (Katayama et al, 2015). O objetivo principal no desenvolvimento desta técnica foi o de mimetizar a abordagem de TAB, utilizada primordialmente no tratamento de pacientes com hipertensão resistente ao tratamento farmacológico De Leeuw et al, 2017;Tordoir et al, 2007), e, também, no tratamento de pacientes com insuficiência cardíaca (Grassi et al, 2016;Gronda et al, 2014). Embora estes estudos clínicos tenham demonstrado que a TAB seja eficiente quanto à redução da PA de pacientes hipertensos resistentes De Leeuw et al, 2017;Scheffers et al, 2010;Tordoir et al, 2007), os mecanismos envolvidos nessa abordagem, e suas possíveis limitações, precisam ser melhor explorados.…”