Neuromodulation Therapy in Heart Failure: Combined Use of Drugs and Devices

Sobowale, Christopher O; Hori, Yuichi; Ajijola, Olujimi A.

doi:10.19102/icrm.2020.110705

Cited by 7 publications

(10 citation statements)

References 102 publications

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“…In patients living with HF, autonomic imbalance with increased sympathetic tone and decreased parasympathetic output is a maladaptive process, leading to increased myocardial workload accelerating further HF progression and decompensation 29 . Stimulation of baroreceptors can lead to decreased sympathetic activity and increase parasympathetic signals, resulting in a reduction in HR, decreased afterload, improved ventriculoarterial coupling and increased diuresis 29 . Likewise, direct vagus nerve stimulation (VNS) by increasing parasympathetic tone reduces HR, myocardial oxygen demand and afterload 29 .…”

Section: Baroreceptor Activation Therapy Rationalementioning

confidence: 99%

“…Stimulation of baroreceptors can lead to decreased sympathetic activity and increase parasympathetic signals, resulting in a reduction in HR, decreased afterload, improved ventriculoarterial coupling and increased diuresis 29 . Likewise, direct vagus nerve stimulation (VNS) by increasing parasympathetic tone reduces HR, myocardial oxygen demand and afterload 29 . Several devices intervening at various anatomical levels of parasympathetic signalling and baroreceptors are in various stages of development.…”

Section: Baroreceptor Activation Therapy Rationalementioning

confidence: 99%

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Transcatheter interventions for heart failure

Latib¹,

Mustehsan²,

Abraham³

et al. 2023

EuroIntervention

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Despite significant advances in the medical management of patients living with heart failure, there continues to be significant morbidity and mortality associated with the condition. There is a growing need for research and development of additional modalities to fill the management and treatment gaps, reduce hospitalisations and improve the quality of life for patients living with heart failure. In the last decade, there has been a rapid rise in the use of non-valvular catheter-based therapies for the management of chronic heart failure to complement existing guideline-directed management. They target well-defined mechanistic and pathophysiological processes critical to the progression of heart failure including left ventricular remodelling, neurohumoral activation, and congestion. In this review, we will explore the physiology, rationale, and current stages of the clinical development of the existing procedures.

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Section: Baroreceptor Activation Therapy Rationalementioning

confidence: 99%

Section: Baroreceptor Activation Therapy Rationalementioning

confidence: 99%

Transcatheter interventions for heart failure

Latib¹,

Mustehsan²,

Abraham³

et al. 2023

EuroIntervention

View full text Add to dashboard Cite

show abstract

“…The prospective, randomized, multicentre SIMPLICITY-HF trial failed to show improvements in cardiac function and HF symptoms at 12 months after renal denervation. 44 Vagus nerve stimulation is aimed at increasing parasympathetic tone and showed promising results in several animal studies. However, these did not translate into benefits when examined in three separate randomized trials of HF patients.…”

Section: Moving Targets Of the Futurementioning

confidence: 99%

“…These trials all employed the Optimizer 3-lead systems, which were recently approved by the US Food and Drug Administration (US FDA). 44 Adverse events, however, seem to relate to the number of leads. Future research in this arena will focus on advancements to minimize device-related AEs, on including patients with non-sinus rhythms, on examining its effects on mortality and HF hospitalizations, and on improving patient selection.…”

Section: Moving Targets Of the Futurementioning

confidence: 99%

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Reflecting on the advancements of HFrEF therapies over the last two decades and predicting what is yet to come

Piña

Gibson

Zieroth

et al. 2022

European Heart Journal Supplements

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What was once considered a topic best avoided, managing heart failure with reduced ejection fraction (HFrEF) has become the focus of many drug and device therapies. While the four pillars of guideline-directed medical therapies have successfully reduced heart failure hospitalizations, and some have even impacted cardiovascular mortality in randomized controlled trials (RCTs), patient-reported outcomes have emerged as important endpoints that merit greater emphasis in future studies. The prospect of an oral inotrope seems more probable now as targets for drug therapies have moved from neurohormonal modulation to intracellular mechanisms and direct cardiac myosin stimulation. While we have come a long way in safely providing durable mechanical circulatory support to patients with advanced HFrEF, several percutaneous device therapies have emerged, and many are under investigation. Biomarkers have shown promise in not only improving our ability to diagnose incident heart failure but also our potential to implicate specific pathophysiological pathways. The once-forgotten concept of discordance between pressure and volume, the forgotten splanchnic venous and lymphatic compartments, have all emerged as promising targets for diagnosing and treating heart failure in the not-so-distant future. The increase in heart failure-related cardiogenic shock (CS) has revived interest in defining optimal perfusion targets and designing RCTs in CS. Rapid developments in remote monitoring, telemedicine, and artificial intelligence promise to change the face of heart failure care. In this state-of-the-art review, we reminisce about the past, highlight the present, and predict what might be the future of HFrEF therapies.

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Neuromodulation interventions in the management of heart failure

Abdin,

Lauder,

Fudim

et al. 2024

European J of Heart Fail

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Despite remarkable improvements in the management of heart failure (HF), HF remains one of the most rapidly growing cardiovascular condition resulting in a substantial burden on healthcare systems worldwide. In clinical practice, however, a relevant proportion of patients are treated with suboptimal combinations and doses lower than those recommended in the current guidelines. Against this background, it remains important to identify new targets and investigate additional therapeutic options to alleviate symptoms and potentially improve prognosis in HF. Therefore, non‐pharmacological interventions targeting autonomic imbalance in HF have been evaluated. This paper aims to review the physiology, available clinical data, and potential therapeutic role of device‐based neuromodulation in HF.

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Neuromodulation Therapy in Heart Failure: Combined Use of Drugs and Devices

Cited by 7 publications

References 102 publications

Transcatheter interventions for heart failure

Transcatheter interventions for heart failure

Reflecting on the advancements of HFrEF therapies over the last two decades and predicting what is yet to come

Neuromodulation interventions in the management of heart failure

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