Cardiology Letters 2020, 29(1):26-33

Baroreceptor activation therapy - new approach in therapy of patients with advanced chronic heart failure and with reduced left ventricular ejection fraction

Dlesk A, Danková M, Lesný P, Luknár M, Gonçalvesová E

Národný ústav srdcových a cievnych chorôb, a. s. v Bratislave, Slovenská republika

Undesirable persistent sympathetic nervous system activation is an important mechanism in pathogenesis of chronic heart failure which is involved in the progression of the disease and negatively affects patient survival. This finding led to the hypothesis that restoring the physiological balance of the autonomic nervous system could delay the progression of heart failure and lead to an improved prognosis of patients with this disease. For this purpose, two therapeutic approaches have been developed and experimentally and clinically tested in the past - vagal nerve stimulation and baroreceptor activation. Direct cervical vagal nerve stimulation involves activation of both afferent and efferent fibers innervating not only the heart, but the entire visceral system, leading to undesirable responses. The action of baroreflex activation is based on decreasing sympathetic activity and increasing parasympathetic activity to the heart via a physiological reflex pathway. Baroreflex activation restores the unbalanced autonomic nervous system via a specific path. Results from previous clinical trials support the hypothesis that baroreflex activation can add significant therapeutic benefit on top of guideline-directed medical therapy in patients with advanced heart failure. Based on the results of a recently published BeAT-HF trial that demonstrated the efficacy and safety of this treatment, baroreceptor activation therapy was approved by the U.S. Food and Drug Administration for the treatment of patients with advanced chronic heart failure. The article provides an overview of experimental and clinical experience with baroreflex activation therapy in patients with heart failure with reduced left ventricular ejection fraction, and briefly discusses our initial experience.

Keywords: chronic heart failure with reduced left ventricular ejection fraction baroreceptor activation therapy; vagal nerve stimulation

Published: January 1, 2020  Show citation