1
|
Shi R, Sun T, Wang M, Xiang Q, Ding Y, Yin S, Chen Y, Shen L, Yu P, Chen X. Baroreflex activation therapy for heart failure with reduced ejection fraction: A comprehensive systematic review and meta-analysis. Heliyon 2024; 10:e24177. [PMID: 38293445 PMCID: PMC10827448 DOI: 10.1016/j.heliyon.2024.e24177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/26/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Background In recent years, baroreflex activation therapy (BAT) has been utilized to treat heart failure with reduced ejection fraction (HFrEF). However, the supporting literature on its efficacy and safety is still limited. This investigation elucidates the effects of BAT in HFrEF patients to provide a reference for future clinical applications. Methods This investigation follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Relevant investigations on the use of BAT in HFrEF patients were searched and selected from 5 databases, including Web of Science, MEDLINE, PubMed, Embase, and Cochrane Library, from inception to December 2022. The methodological quality of eligible articles was assessed via the Cochrane risk of bias tool, and for meta-analysis, RevMan (5.3) was used. Results Randomized controlled trials comprising 343 participants were selected for the meta-analysis, which revealed that in HFrEF patients, BAT enhanced the levels of LVEF (MD: 2.97, 95 % CI: 0.53 to 5.41), MLHFQ (MD: -14.81, 95 % CI: -19.57 to -10.06) and 6MWT (MD: 68.18, 95 % CI: 51.62 to 84.74), whereas reduced the levels of LVEDV (MD: -15.79, 95 % CI: -32.96 to 1.37) and DBP (MD: -2.43, 95 % CI: -4.18 to -0.68). Conclusion It was concluded that BAT is an efficient treatment option for HFrEF patients. However, to validate this investigation, further randomized clinical trials with multiple centers and large sample sizes are needed.
Collapse
Affiliation(s)
- Ruijie Shi
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Tong Sun
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mengxi Wang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Qian Xiang
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuhan Ding
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Siyuan Yin
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
- First Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Chen
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Le Shen
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Peng Yu
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| | - Xiaohu Chen
- Department of Cardiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- Department of Cardiology, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China
| |
Collapse
|
2
|
Cai G, Guo K, Zhang D, Qin S. The efficacy of baroreflex activation therapy for heart failure: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e22951. [PMID: 33157936 PMCID: PMC7647578 DOI: 10.1097/md.0000000000022951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The efficacy of baroreflex activation therapy for heart failure is elusive. This meta-analysis aims to evaluate the impact of baroreflex activation therapy on treatment efficacy of heart failure. METHODS Several databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases have been searched, and we include randomized controlled trials (RCTs) regarding the efficacy of baroreflex activation therapy for patients with heart failure. RESULTS This meta-analysis includes 4 RCTs. Baroreflex activation therapy shows significantly positive impact on the quality of life score (standard mean difference SMD = -4.61; 95% confidence interval CI = -6.24 to -2.98; P < .00001), 6-minute hall walk (6MHW) distance (SMD = 2.83; 95% CI = 1.44- 4.22; P < .0001), New York Heart Association (NYHA) Class (SMD = -3.23; 95% CI = -4.76 to -1.69; P < .0001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (SMD = -1.24; 95% CI = -1.58 to -0.89; P < .00001) and the duration of hospitalization (SMD = -1.65; 95% CI = -2.90 to -0.39; P = .01) compared with control group for heart failure, but has no obvious effect on left ventricular ejection fraction (LVEF) (SMD = 1.43; 95% CI = -0.15-3.01; P = .08), or the number of hospitalization per year (SMD = -1.17; 95% CI = -2.56-0.22; P = .10). CONCLUSIONS Baroreflex activation therapy can improve the treatment efficacy for heart failure.
Collapse
Affiliation(s)
- Guoqiang Cai
- Department of Cardiology, Dianjiang Traditional Chinese Medicine Hospital, Dianjiang
| | - Kai Guo
- Department of Cardiology, Dianjiang Traditional Chinese Medicine Hospital, Dianjiang
| | - Dongyin Zhang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| | - Shu Qin
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, PR China
| |
Collapse
|
3
|
Zile MR, Lindenfeld J, Weaver FA, Zannad F, Galle E, Rogers T, Abraham WT. Baroreflex Activation Therapy in Patients With Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol 2020; 76:1-13. [DOI: 10.1016/j.jacc.2020.05.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
|
4
|
Zeitler EP, Abraham WT. Novel Devices in Heart Failure. JACC-HEART FAILURE 2020; 8:251-264. [DOI: 10.1016/j.jchf.2019.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/28/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022]
|
5
|
Johnson V, Hamm CW, Schmitt J. [Device-device interaction]. Herzschrittmacherther Elektrophysiol 2019; 30:183-190. [PMID: 30989336 DOI: 10.1007/s00399-019-0617-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/24/2019] [Indexed: 06/09/2023]
Abstract
With a continuous increase in the approval of cardiac implantable electronic devices (CIED), not only pacemakers (PM) and implantable cardioverter defibrillators (ICD) but especially devices for treating chronic heart failure, more and more possibilities of device-device interactions arise, which in isolated cases can lead to death of the patient. Because of the still low numbers of patients overall, there are very few scientific studies and only isolated case reports on this topic. Devices which are at risk of interaction with a previously implanted PM are wearable cardioverter defibrillators (WCD) and subcutaneous ICDs (S-ICD). These two devices both use the surface electrocardiogram (ECG) in their algorithm for detecting ventricular arrhythmia. These surface ECGs seem to be prone to unipolar pacemaker stimulation artefacts. By correct programming of implanted pacemakers in the bipolar stimulation mode it is possible to avoid ECG artefacts and inadequate treatment. In baroreceptor activation therapy (BAT) there seem to be no device interactions so far, even though this device shows substantial highly frequent artefacts in the ECG. The cardiac contractility modulation (CCM) system has also until now not shown interactions with transvenous or subcutaneous ICD devices, even though randomized trials are missing.
Collapse
Affiliation(s)
- Victoria Johnson
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland.
- Deutsches Zentrum für Herzinsuffizienz, Translationale Forschung, Uniklinikum Würzburg, Würzburg, Deutschland.
| | - Christian W Hamm
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland
| | - Jörn Schmitt
- Med. Klinik I, Abteilung für Kardiologie und Angiologie, Universitätsklinik Gießen, UKGM, Klinikstraße 33, 35392, Gießen, Deutschland
| |
Collapse
|
6
|
Mann JA, Abraham WT. Cardiac Contractility Modulation and Baroreflex Activation Therapy in Heart Failure Patients. Curr Heart Fail Rep 2019; 16:38-46. [DOI: 10.1007/s11897-019-0422-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
7
|
Santini M, Santini L, Di Fusco SA. Update on cardiac implantable electronic devices: from the injectable loop recorder to the leadless pacemaker, to the subcutaneous defibrillator. Minerva Cardioangiol 2018; 66:762-769. [DOI: 10.23736/s0026-4725.18.04693-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
8
|
First granted example of novel FDA trial design under Expedited Access Pathway for premarket approval: BeAT-HF. Am Heart J 2018; 204:139-150. [PMID: 30118942 DOI: 10.1016/j.ahj.2018.07.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/19/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Food and Drug Administration (FDA) initiated the Expedited Access Pathway (EAP) to accelerate approval of novel therapies targeting unmet needs for life-threatening conditions. EAP allows for the possibility of initial FDA approval using intermediate end points with postapproval demonstration of improved outcomes. OBJECTIVE Describe the EAP process using the BeAT-HF trial as a case study. METHODS BeAT-HF will examine the safety and effectiveness of baroreflex activation therapy (BAT) in heart failure patients with reduced ejection fraction using an Expedited and Extended Phase design. In the Expedited Phase, BAT plus guideline-directed medical therapy (GDMT) will be compared at 6 months postimplant to GDMT alone using 3 intermediate end points: 6-minute hall walk distance, Minnesota Living with Heart Failure Questionnaire, and N-terminal pro-B-type natriuretic peptide. The rate of heart failure morbidity and cardiovascular mortality will be compared between the arms to evaluate early trending using predictive probability modeling. Sample size of 264 patients randomized 1:1 to BAT + GDMT versus GDMT alone provides 81% power for the Expedited Phase intermediate end points. For the Extended Phase, the heart failure morbidity and cardiovascular mortality end point is based on an expected event rate of 0.4 events/patient/year in the GDMT arm. With an adaptive sample size selection design for robustness to inaccurate assumptions, a sample size of 480-960 randomized patients followed ≥2 years allows detecting a 30% reduction in the primary end point with a power of 97.5%. CONCLUSION Through a unique collaboration with FDA under the EAP, the BeAT-HF trial design allows for the possibility of approval of BAT, initially for symptom relief and subsequently for outcomes improvement.
Collapse
|
9
|
Halbach M, Abraham WT, Butter C, Ducharme A, Klug D, Little WC, Reuter H, Schafer JE, Senni M, Swarup V, Wachter R, Weaver FA, Wilks SJ, Zile MR, Müller-Ehmsen J. Baroreflex activation therapy for the treatment of heart failure with reduced ejection fraction in patients with and without coronary artery disease. Int J Cardiol 2018; 266:187-192. [DOI: 10.1016/j.ijcard.2018.04.075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/01/2018] [Accepted: 04/17/2018] [Indexed: 11/28/2022]
|
10
|
Safety profile of baroreflex activation therapy (NEO) in patients with resistant hypertension. J Hypertens 2018; 36:1762-1769. [DOI: 10.1097/hjh.0000000000001753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Kuffer L, Steven D, Halbach M, Lüker J, van den Bruck JH, Sultan A. Combination of a subcutaneous ICD in a patient with a baroreceptor activation device: Feasibility, safety, and precautions: A Case Report. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:1486-1488. [DOI: 10.1111/pace.13109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/21/2017] [Accepted: 04/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Liz Kuffer
- Department of Electrophysiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| | - Daniel Steven
- Department of Electrophysiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| | - Marcel Halbach
- Department of Cardiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| | - Jakob Lüker
- Department of Electrophysiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| | - Jan-Hendrik van den Bruck
- Department of Electrophysiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| | - Arian Sultan
- Department of Electrophysiology, University Heart Centre Cologne; University Hospital Cologne; Cologne Germany
| |
Collapse
|
12
|
Weipert KF, Andrick J, Chasan R, Gemein C, Most A, Hamm CW, Erkapic D, Schmitt J. Baroreceptor stimulation in a patient with preexisting subcutaneous implantable cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:90-92. [DOI: 10.1111/pace.13115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 02/22/2017] [Accepted: 05/02/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Kay F. Weipert
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Jens Andrick
- Department of Cardiovascular Surgery; University of Giessen; Giessen Germany
| | - Ritvan Chasan
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Christopher Gemein
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Astrid Most
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Christian W. Hamm
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Damir Erkapic
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| | - Joern Schmitt
- Division of Cardiology, Department of Internal Medicine I; University of Giessen; Giessen Germany
| |
Collapse
|
13
|
Baroreflex Activation Therapy in Heart Failure With Reduced Ejection Fraction: Available Data and Future Perspective. Curr Heart Fail Rep 2016; 13:71-6. [PMID: 26879389 DOI: 10.1007/s11897-016-0286-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Progression of heart failure with reduced ejection fraction (HFrEF) is promoted by sympathovagal imbalance. Baroreflex activation therapy, i.e., electrical stimulation of baroreceptors at the carotid sinus, can restore sympathovagal balance. Large animal studies of baroreflex activation therapy revealed improvements in cardiac function, susceptibility to ventricular arrhythmias, and a survival benefit as compared to untreated controls. Recently, the first randomized and controlled trial of optimal medical and device therapy alone or plus baroreflex activation therapy in patients suffering from HFrEF was published. It demonstrated a reasonable safety profile in this severely ill patient population. Moreover, the study found significant improvements in New York Heart Association class, quality of life, 6-min walk distance, and NT-proBNP levels. This review provides an overview on baroreflex activation therapy for the treatment of HFrEF-from the concept and preclinical findings to most recent clinical data and upcoming trials.
Collapse
|
14
|
Brognara F, Dias DPM, Castania JA, Fazan R, Lewis SJ, Salgado HC. Cardiovascular responses elicited by continuous versus intermittent electrical stimulation of the aortic depressor nerve in conscious rats. Life Sci 2016; 148:99-105. [PMID: 26876918 DOI: 10.1016/j.lfs.2016.02.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 12/01/2022]
Abstract
AIMS Short-term (seconds or minutes) continuous electrical activation of the aortic depressor nerve (ADN) in conscious rats has been successfully used to investigate baroafferent function in experimental hypertension, heart failure, and peripheral inflammation. The aim of this study was to characterize the hemodynamic responses elicited by longer periods (60min) of continuous or intermittent electrical baroreflex activation. MAIN METHODS Wistar rats were implanted with an electrode around the left ADN and a catheter into a femoral artery. The systolic, diastolic and mean arterial pressure and heart rate were recorded in subjects randomly assigned to continuous or intermittent electrical stimulation. The time-course of cardiovascular responses in conscious rats was examined during longer-term (60min) continuous (n=6) or intermittent (5s ON/3s OFF; n=10) electrical stimulation (0.5mA; 0.25ms; 30Hz) of the ADN. KEY FINDINGS The prompt (20s) hypotensive response was greater under continuous stimulation, but no difference was detected in the bradycardic response. The hypotensive response was sustained only by continuous stimulation while no sustained bradycardia was observed in either protocol. SIGNIFICANCE These findings indicate that continuous stimulation of the ADN is more effective in reducing arterial pressure over a longer period (60min) of stimulation. Nevertheless, both protocols - continuous or intermittent - were unable to elicit a sustained bradycardia.
Collapse
Affiliation(s)
- Fernanda Brognara
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Daniel P Martins Dias
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jaci A Castania
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Rubens Fazan
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Stephen J Lewis
- Department of Pediatrics, Division of Pulmonology, Allergy and Immunology, Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Helio C Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
15
|
Halbach M, Fritz T, Madershahian N, Pfister R, Reuter H. [Baroreflex activation therapy. A novel interventional approach to treat heart failure with reduced ejection fraction]. Herz 2015; 40:959-65. [PMID: 26525523 DOI: 10.1007/s00059-015-4361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sympathovagal imbalance plays an important role in the progression of heart failure with reduced ejection fraction. Baroreflex activation therapy (BAT), i. e. electrical stimulation of baroreceptors located at the carotid sinus, can reduce sympathetic and enhance parasympathetic tone. Large animal studies on BAT demonstrated improvements in cardiac function, arrhythmogenic risk and a survival benefit compared to untreated controls. The recently published Neo Randomized Heart Failure Study, the first multicenter, randomized and controlled trial of optimal medical and device therapy alone or plus BAT in patients with a left ventricular ejection fraction ≤ 35 %, demonstrated a reasonable safety profile of BAT in this severely ill patient population and no relevant interactions with other devices. The study found significant improvements in the New York Heart Association (NYHA) class of heart failure, quality of life as well as 6 min walking distance and data pointed to a reduction in hospitalization rates. Moreover, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly reduced. This review gives an overview on BAT for the treatment of heart failure with reduced ejection fraction, from the rationale and animal experiments to the most recent clinical data and future perspectives.
Collapse
Affiliation(s)
- M Halbach
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - T Fritz
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - N Madershahian
- Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Uniklinik Köln, Köln, Deutschland
| | - R Pfister
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - H Reuter
- Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| |
Collapse
|
16
|
Zhang D, Muelleman RL, Li YL. Angiotensin II-superoxide-NFκB signaling and aortic baroreceptor dysfunction in chronic heart failure. Front Neurosci 2015; 9:382. [PMID: 26528122 PMCID: PMC4607814 DOI: 10.3389/fnins.2015.00382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/02/2015] [Indexed: 11/13/2022] Open
Abstract
Chronic heart failure (CHF) affects approximately 5.7 million people in the United States. Increasing evidence from both clinical and experimental studies indicates that the sensitivity of arterial baroreflex is blunted in the CHF state, which is a predictive risk factor for sudden cardiac death. Normally, the arterial baroreflex regulates blood pressure and heart rate through sensing mechanical alteration of arterial vascular walls by baroreceptor terminals in the aortic arch and carotid sinus. There are aortic baroreceptor neurons in the nodose ganglion (NG), which serve as the main afferent component of the arterial baroreflex. Functional changes of baroreceptor neurons are involved in the arterial baroreflex dysfunction in CHF. In the CHF state, circulating angiotensin II (Ang II) and local Ang II concentration in the NG are elevated, and AT1R mRNA and protein are overexpressed in the NG. Additionally, Ang II-superoxide-NFκB signaling pathway regulates the neuronal excitability of aortic baroreceptors through influencing the expression and activation of Nav channels in aortic baroreceptors, and subsequently causes the impairment of the arterial baroreflex in CHF. These new findings provide a basis for potential pharmacological interventions for the improvement of the arterial baroreflex sensitivity in the CHF state. This review summarizes the mechanisms responsible for the arterial baroreflex dysfunction in CHF.
Collapse
Affiliation(s)
- Dongze Zhang
- Department of Emergency Medicine, University of Nebraska Medical Center Omaha, NE, USA
| | - Robert L Muelleman
- Department of Emergency Medicine, University of Nebraska Medical Center Omaha, NE, USA
| | - Yu-Long Li
- Department of Emergency Medicine, University of Nebraska Medical Center Omaha, NE, USA
| |
Collapse
|
17
|
Ong AA, O'Brien TX, Nguyen SA, Gillespie MB. Implantation of a defibrillator in a patient with an upper airway stimulation device. Laryngoscope 2015; 126:E86-9. [PMID: 26403681 DOI: 10.1002/lary.25683] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2015] [Indexed: 11/07/2022]
Abstract
The patient is a 62-year-old man with continuous positive airway pressure-intolerant obstructive sleep apnea who was enrolled in a study for a hypoglossal nerve upper airway stimulation device (UAS). Nearly 2.5 years later, he was admitted to the hospital for unstable angina. Diagnostic workup revealed a prior myocardial infarction, an ejection fraction of 30% on maximal medical therapy, and episodes of nonsustained ventricular tachycardia. During hospitalization, the patient received an implantable cardioverter defibrillator (ICD). This is the first reported case of simultaneous use of a UAS and an ICD, and we report no untoward device interference between the two implantable devices.
Collapse
Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Terrence X O'Brien
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| |
Collapse
|
18
|
|
19
|
|
20
|
Zile MR, Abraham WT, Weaver FA, Butter C, Ducharme A, Halbach M, Klug D, Lovett EG, Müller‐Ehmsen J, Schafer JE, Senni M, Swarup V, Wachter R, Little WC. Baroreflex activation therapy for the treatment of heart failure with a reduced ejection fraction: safety and efficacy in patients with and without cardiac resynchronization therapy. Eur J Heart Fail 2015; 17:1066-74. [DOI: 10.1002/ejhf.299] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 01/19/2023] Open
Affiliation(s)
- Michael R. Zile
- Division of Cardiology, Department of Medicine Medical University of South Carolina 114 Doughty Street, Thurmond/Gazes, 323, Charleston, SC 29425, USA and Ralph H. Johnson Department of Veterans Affairs Medical Center Charleston SC USA
| | - William T. Abraham
- Division of Cardiovascular Medicine The Ohio State University Columbus OH USA
| | - Fred A. Weaver
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine University of Southern California Los Angeles CA USA
| | - Christian Butter
- Department of Cardiology Immanuel Heart Center Bernau—Medical School Brandenburg Bernau Germany
| | - Anique Ducharme
- Montreal Heart Institute University of Montréal Montreal Quebec Canada
| | - Marcel Halbach
- Department of Internal Medicine III University Hospital of Cologne Cologne Germany
| | - Didier Klug
- Department of Cardiology A University Hospital Lille France
| | | | | | | | - Michele Senni
- Cardiovascular Department Ospedale Papa Giovanni XXIII Bergamo Italy
| | - Vijay Swarup
- Department of Electrophysiology Arizona Heart Hospital Phoenix AZ USA
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology University Medicine Göttingen and German Cardiovascular Research Center (DZHK) Göttingen Germany
| | - William C. Little
- Division of Cardiology University of Mississippi Medical Center Jackson MS USA
| |
Collapse
|
21
|
Abraham WT, Zile MR, Weaver FA, Butter C, Ducharme A, Halbach M, Klug D, Lovett EG, Müller-Ehmsen J, Schafer JE, Senni M, Swarup V, Wachter R, Little WC. Baroreflex Activation Therapy for the Treatment of Heart Failure With a Reduced Ejection Fraction. JACC-HEART FAILURE 2015; 3:487-496. [PMID: 25982108 DOI: 10.1016/j.jchf.2015.02.006] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The objective of this clinical trial was to assess the safety and efficacy of carotid BAT in advanced HF. BACKGROUND Increased sympathetic and decreased parasympathetic activity contribute to heart failure (HF) symptoms and disease progression. Baroreflex activation therapy (BAT) results in centrally mediated reduction of sympathetic outflow and increased parasympathetic activity. METHODS Patients with New York Heart Association (NYHA) functional class III HF and ejection fractions ≤35% on chronic stable guideline-directed medical therapy (GDMT) were enrolled at 45 centers in the United States, Canada, and Europe. They were randomly assigned to receive ongoing GDMT alone (control group) or ongoing GDMT plus BAT (treatment group) for 6 months. The primary safety end point was system- and procedure-related major adverse neurological and cardiovascular events. The primary efficacy end points were changes in NYHA functional class, quality-of-life score, and 6-minute hall walk distance. RESULTS One hundred forty-six patients were randomized, 70 to control and 76 to treatment. The major adverse neurological and cardiovascular event-free rate was 97.2% (lower 95% confidence bound 91.4%). Patients assigned to BAT, compared with control group patients, experienced improvements in the distance walked in 6 min (59.6 ± 14 m vs. 1.5 ± 13.2 m; p = 0.004), quality-of-life score (-17.4 ± 2.8 points vs. 2.1 ± 3.1 points; p < 0.001), and NYHA functional class ranking (p = 0.002 for change in distribution). BAT significantly reduced N-terminal pro-brain natriuretic peptide (p = 0.02) and was associated with a trend toward fewer days hospitalized for HF (p = 0.08). CONCLUSIONS BAT is safe and improves functional status, quality of life, exercise capacity, N-terminal pro-brain natriuretic peptide, and possibly the burden of heart failure hospitalizations in patients with GDMT-treated NYHA functional class III HF. (Barostim Neo System in the Treatment of Heart Failure; NCT01471860; Barostim HOPE4HF [Hope for Heart Failure] Study; NCT01720160).
Collapse
Affiliation(s)
- William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
| | - Michael R Zile
- Medical University of South Carolina, Charleston, South Carolina; Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Christian Butter
- Department of Cardiology, Immanuel Heart Center Bernau - Medical School Brandenburg, Bernau, Germany
| | - Anique Ducharme
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Marcel Halbach
- Department of Internal Medicine III, University Hospital of Cologne, Cologne, Germany
| | - Didier Klug
- Department of Cardiology A, University Hospital, Lille, France
| | - Eric G Lovett
- Department of Research, CVRx, Inc., Minneapolis, Minnesota
| | | | - Jill E Schafer
- Department of Statistics, NAMSA, Inc., Minneapolis, Minnesota
| | - Michele Senni
- Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Vijay Swarup
- Department of Electrophysiology, Arizona Heart Hospital, Phoenix, Arizona
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, University Medicine Göttingen and German Cardiovascular Research Center, Göttingen, Germany
| | - William C Little
- Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi
| |
Collapse
|
22
|
Electrical carotid baroreceptor stimulation. Wien Med Wochenschr 2014; 164:508-14. [DOI: 10.1007/s10354-014-0329-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
|