title: [Baroreflex activation therapy. A novel interventional approach to treat heart failure with reduced ejection fraction].
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.
authors.affiliation: Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland. marcel.halbach@uk-koeln.de.
authors.forename: M
authors.initials: M
authors.lastname: Halbach
authors.affiliation: Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Fritz
authors.affiliation: Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Uniklinik Köln, Köln, Deutschland.
authors.forename: N
authors.initials: N
authors.lastname: Madershahian
authors.affiliation: Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Pfister
authors.affiliation: Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Reuter
mesh_terms: D017704:Baroreflex; D002908:Chronic Disease; D004599:Electric Stimulation Therapy / Q000379:methods*; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D011311:Pressoreceptors; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control*
keywords: Baroreceptors; Baroreflex activation therapy; Carotid sinus stimulation; Heart failure; Nervous system