Key result
Endovascular aortic neuromodulation boosts 6MWD by ~71m and improves remodeling in HFpEF patient.
Why the study?
Inadequacy of medical therapies for HFpEF is driving the development of device-based solutions targeting autonomic imbalance, which contributes to worsening cardiac performance and increased morbidity and mortality.
Does chronic endovascular stimulation of aortic vagal afferents improve cardiac function and symptoms in patients with HFpEF?
Case Report (n=1)
Does chronic endovascular stimulation of aortic vagal afferents improve cardiac function and symptoms in patients with HFpEF?
This first-in-man experience suggests that endovascular stimulation of aortic thoracic afferents may be a promising device-based treatment to improve cardiac structure, function, and symptoms in HFpEF.
The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device-based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance. In this first-in-man experience with chronic stimulation of aortic vagal afferents (Harmony™ System, Enopace, Israel), we demonstrate improved left atrial remodelling and function parallel with improved left ventricular performance. The observed favourable structural and functional cardiac changes remained stable throughout the 1 year follow-up and were associated with improved symptoms and physical fitness. The current experience warrants further validation of the endovascular stimulation of aortic thoracic afferents as a new interventional approach for device-based treatment in HFpEF.
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Paolisso et al. (2022) conducted a case report in Heart failure with preserved ejection fraction (HFpEF) (n=1). Aortic thoracic neuromodulation (Harmony™ System) was evaluated on Safety and early efficacy signals (cardiac structure, function, and physical fitness). Endovascular thoracic aorta neuromodulation in a 71-year-old man with HFpEF improved left atrial remodeling, left ventricular performance, and increased 6-minute walk distance from 357m to 428m at 1 year.
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