title: Sympathetic Activation in Chronic Heart Failure: Potential Benefits of Interventional Therapies.
abstract: Heart failure (HF) is a major and growing public health problem. This condition is associated with poor prognosis, a high rate of mortality, frequent hospitalization and increasing costs to health care systems. Pharmacological approaches aimed at reducing morbidity and mortality in HF have primarily focused on inhibition of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), both of which have been associated with disease development, progression and adverse cardiovascular (CV) outcomes. The increasing number of hospitalizations for HF decompensation suggests the failure of available treatment options, indicating the necessity for alternative therapeutic approaches. Alongside pharmacological and cardiac resynchronization therapies in selected patients with arrhythmia, recent advancements in the management of HF have been directed at inhibiting relevant neurogenic pathways underlying disease development and progression. Initial evidence regarding the safety and effectiveness of interventional procedures suggests that HF patients may benefit from novel adjunctive therapies. Here we review the critical role of sympathetic activation in HF and the rationale for therapeutic interventions including device-based and interventional approaches aimed at restoring autonomic neural balance in this condition.
authors.affiliation: First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Kamila
authors.initials: K
authors.lastname: Lachowska
authors.affiliation: First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Gruchała
authors.affiliation: Department of Hypertension and Diabetology, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Narkiewicz
authors.affiliation: Dobney Hypertension Centre, School of Medicine and Pharmacology-Royal Perth Hospital Unit, The University of Western Australia, Level 3 MRF Building, Rear 50 Murray Street, Perth, WA, 6000, MDBP: M570, Australia. dagmara.hering@uwa.edu.au.
authors.forename: Dagmara
authors.initials: D
authors.lastname: Hering
mesh_terms: D000818:Animals; D002908:Chronic Disease; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006973:Hypertension / Q000150:complications; D012084:Renin-Angiotensin System; D012307:Risk Factors
keywords: Cardiovascular risk; Heart failure; Interventional therapy; Mortality; Pharmacological drugs; Reflex neural mechanisms; Sympathetic nervous system activity