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Baroreflex activation therapy through electrical carotid sinus stimulation
Jens Jordan1, Jens Tank2, Karsten Heusser2
1Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Medical Faculty, University of Cologne, Cologne, Germany.
Abstract:
An imbalance between cardiovascular parasympathetic and sympathetic activity towards sympathetic predominance has been implicated in the pathogenesis of treatment-resistant arterial hypertension and heart failure. Arterial baroreceptors control efferent cardiovascular autonomic activity and have, therefore, been recognized as potential treatment targets. Baroreflex activation therapy through electrical carotid sinus stimulation is a device-based approach to modulate cardiovascular autonomic activity. Electrical carotid sinus stimulation lowered blood pressure in various hypertensive animal models and improved cardiac remodeling and survival in preclinical models of heart failure. In human mechanistic profiling studies, electrical carotid sinus stimulation lowered blood pressure through sympathetic inhibition with substantial inter-individual variability. The first-generation device reduced blood pressure in controlled and uncontrolled clinical trials. Controlled clinical trials proving efficacy in blood pressure reduction in patients with hypertension do not exist for the currently available second-generation carotid sinus stimulator. Investigations in heart failure patients showed improved symptoms, quality of life, and natriuretic peptide biomarkers. Electrical carotid sinus stimulation is an interesting technology to modulate cardiovascular autonomic control. However, controlled trials with hard clinical endpoints are required.
Insights
Baroreflex activation therapy using electrical carotid sinus stimulation shows promise for treating resistant hypertension and heart failure by modulating autonomic activity. Further controlled trials are needed to confirm its efficacy and clinical benefits.
Area of Science:
- Cardiovascular autonomic regulation
- Hypertension and heart failure pathogenesis
- Baroreflex modulation
Background:
- Sympathetic overactivity contributes to resistant hypertension and heart failure.
- Arterial baroreceptors are key regulators of autonomic activity and potential therapeutic targets.
- Baroreflex activation therapy (BAT) aims to restore autonomic balance.
Purpose of the Study:
- To evaluate the efficacy of electrical carotid sinus stimulation (ECSS) in modulating cardiovascular autonomic activity.
- To assess the impact of ECSS on blood pressure, cardiac remodeling, and heart failure symptoms.
- To review the current evidence and identify the need for further clinical trials.
Main Methods:
- Device-based neuromodulation via electrical stimulation of the carotid sinus.
- Preclinical studies in animal models of hypertension and heart failure.
- Human mechanistic profiling studies and clinical trials in hypertensive and heart failure patients.
Main Results:
- ECSS demonstrated blood pressure reduction in animal models and human studies, primarily via sympathetic inhibition.
- Preclinical data showed improvements in cardiac remodeling and survival in heart failure models.
- Heart failure patients experienced improved symptoms, quality of life, and biomarker profiles.
Conclusions:
- Electrical carotid sinus stimulation is a viable technology for modulating cardiovascular autonomic control.
- While promising, controlled clinical trials with hard endpoints are essential to establish efficacy for hypertension.
- Further research is needed to validate the benefits of ECSS in heart failure management.
