Leveraging the Autonomic Nervous System to Give Patients with Heart Failure a New Option

Leveraging the Autonomic Nervous System to Give Patients with Heart Failure a New Option.

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For many patients with heart failure with reduced ejection fraction (HFrEF), medications or a device such as a biventricular pacemaker can help relieve symptoms and extend life. Yet for some patients, these treatments may not lead to significant improvement. 


Barostim™ is an exciting new device that targets the body’s autonomic nervous system to offer another option.  


Implanted inside the body—but outside the heart and vascular system—Barostim sends electrical pulses to the carotid artery to help the heart relax. This results in improvement of symptoms, quality of life and exercise capacity beyond what might be achieved with medications alone.


About 6.7 million people in the U.S. have heart failure, and approximately 50% of them have HFrEF, when the heart’s left ventricle doesn’t pump out all the blood it contains with each contraction. This can cause challenging symptoms, such as:

  • Fatigue

  • Weakness

  • Lack of appetite

  • Shortness of breath with exertion

  • Difficulty breathing when lying down

  • Weight gain and swelling in the ankles, feet, or legs

Traditional treatments for HFrEF work well for many people. Guideline-directed medical therapy (GDMT)—a combination of medications such as diuretics, beta-blockers, ACE inhibitors, and other drugs—has huge benefits and can slow the progression of the disease, however for many reasons (intolerance, side-effects, cost) GDMT may be inadequate in fully reducing risk of progression or alleviating symptoms. While cardiac resynchronization therapy (CRT) with a pacemaker device can help improve symptoms and exercise capacity, only 30% of HFrEF patients are eligible for the device. 


Patients who remain symptomatic and exercise-limited despite these treatments now have another option: Barostim. 


An option between medication and major surgery.

Barostim is designed for patients with HFrEF with an ejection fraction of 35% or lower for whom GDMT and CRT fail to improve symptoms. Generally, better results are seen the earlier a Barostim device is implanted, before heart failure has progressed to later stages.


We work with patients to assess their disease progression and optimize their medical therapy and CRT device if they have one. If patients remain symptomatic, they consult with a cardiologist or heart failure specialist to determine whether they are a candidate for Barostim. 

Patients who have late-stage or advanced heart failure may not benefit from the device and would get better results with an LVAD or a heart transplant. We help make this assessment to ensure success with any recommended therapy. 


Related reading: Research Evaluates Cinching Device to Relieve Symptoms of Heart Failure.


How Barostim helps the heart and blood vessels relax.

Barostim is unique because the device influences the heart without being in contact with it. This is because Barostim impacts the autonomic nervous system, which works in the background to keep heart rate, digestion, breathing, and other important bodily functions on track. 


The autonomic nervous system has two primary parts:

  • Sympathetic fibers: These regulate the body’s “fight-or-flight” response to stress.

  • Parasympathetic fibers: These “rest-and-digest” fibers help the body know it’s time to relax.

Barostim works similarly to GDMT, in which medications block the detrimental neurohormones that are released because of sympathetic response. The device sends pulses from a small generator implanted in the chest wall through a thin wire to pressure sensors (or baroreceptors) in the carotid artery in the neck. Stimulating these receptors activates the parasympathetic fibers and causes sympathetic fibers to withdraw. 


Like GDMT, this reduces the release of damaging stress/neurohormones and encourages the heart and blood vessels to relax, breaking the negative feedback cycle of sympathetic stimuli that progressively weakens the heart in patients with heart failure. 


The device can be implanted by a vascular or cardiac surgeon, leaving the patient with only two small incisions—one in the neck and another in the chest. Patients typically go home the same day of the procedure and can resume even strenuous activities after a few weeks. 


Over subsequent weeks after implant, we work with patients to gradually increase the strength of the impulse to achieve maximum symptom relief without extra sensation. When properly adjusted, patients don’t notice Barostim at work, except for a reduction in their symptoms. 


Related reading: Can an App Save Lives by Improving Treatment for Heart Failure?


Patients feel better with Barostim.

In the clinical trials that led to Barostim’s approval, researchers demonstrated that adding the device to GDMT resulted sustained symptom improvement for patients:

  • They were able to exercise more

  • They reported significant improvement in their quality of life 

  • Their functional status improved (27% more patients than in the control group showed improvement in their functional status class)

  • They had lower need for additional heart failure devices or interventions, compared to control

  • 94% of patients felt better with Barostim

MedStar Health began its Barostim program in January 2023 and has implanted more than 20 patients to date with no procedural complications and about 90% of patients reporting improvement in symptoms. While there are no published data regarding this, we and other centers have anecdotally observed that after Barostim, some patients are able to tolerate increase in GDMT medications that could improve outcomes in the long term. 


Bartostim offers patients with HFrEF an exciting new option to complement GDMT or CRT. We hope novel device therapy in heart failure can extend the time before possibly needing heart transplant or LVAD, while reducing their symptoms and improving their quality of life.


Bothered by heart failure symptoms despite treatment? We can help.

Request an appointment today.

Call 202-877-4485 or Request an Appointment

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