Key result
Baroreceptor activation therapy remains the only neuromodulation strategy with sufficient RCT evidence for symptomatic HFrEF.
Why the study?
Autonomic imbalance is common in HFrEF, but among various neuromodulation targets evaluated to address it, their clinical evidence and roles in practice vary.
Baroreceptor activation therapy is currently the only neuromodulation strategy with sufficient evidence for clinical use in symptomatic HFrEF patients despite optimal medical therapy.
Supports consideration of baroreceptor activation therapy in symptomatic HFrEF; leaves open other neuromodulation strategies pending further RCTs.
Autonomic imbalance is a common finding in heart failure (HF) with reduced ejection fraction (HFrEF). Addressing different targets within the autonomic nervous systems has been evaluated in patients with HF, including renal sympathetic denervation, vagal nerve stimulation, and baroreceptor activation therapy (BAT). Although all are pathophysiologically plausible and promising, only BAT shows sufficient evidence for implementation into clinical practice in randomized controlled trials. Baroreceptor activation therapy can be used in patients with symptomatic HFrEF despite optimal guideline-directed medication and device therapy. This article reviews the current and future use of neuromodulation in HF and provides an overview on current guideline recommendations and clinical practice.
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Duncker et al. (2022) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Neuromodulation (baroreceptor activation therapy, renal sympathetic denervation, vagal nerve stimulation) was evaluated. Baroreceptor activation therapy is currently the only neuromodulation strategy with sufficient evidence from randomized controlled trials for implementation into clinical practice for symptomatic HFrEF.
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