Extra-Cardiac Targets in the Management of Cardiometabolic Disease: Device-Based Therapies

Figures

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  Figure 1. Central figure. Heart failure and co‐morbid diseases are characterized by an elevated sympathetic tone. Co‐morbidities contribute to heart failure progression by an additional dysregulation of the neurohormonal state. Novel device‐based therapies targeting neurohormonal dysregulation present a new therapeutic avenue for the treatment of HF and related co‐morbidities.

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  Figure 2. Baroreceptor activation therapy. (A) Anatomy of the carotid sinus, carotid artery and baroreceptors. (B) A pulse generator placed under the skin near the clavicle. (C) A lead attaching onto the carotid artery.

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  Figure 3. Volume redistribution concept in heart failure and splanchnic nerve modulation as a novel therapeutic intervention.

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  Figure 4. Renal denervation therapy. Increased end organ sympathetic outflow via efferent pathways causes renal sodium and water retention, systemic vasoconstriction and cardiac and vascular hypertrophy. Renal denervation reduces sympathetic tone, showing potential in treatment of sympathetically mediated diseases including HF. BNP, brain natriuretic peptide; RAAS, renin–angiotensin–aldosterone system; SNS, sympathetic nervous system.

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  Figure 5. Cardiac neuromodulation therapy BackBeat. (A,B) Implantable pulse generator that connects to the heart with standard pacing leads and delivers BackBeat CNT to lower blood pressure. (C,D) A repeating sequence of paced heartbeats with variable AV delays, ultrashort AV delay beats to lower blood pressure and longer AV delay to modulate autonomic reflex responses via baro/stretch receptors.

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  Figure 6. Phrenic nerve stimulation with remedē System. (A) Parts of remedē System: pulse generator implanted below clavicle, stimulation lead placed either in left pericardiophrenic or right brachiocephalic vein and a sensing lead helping to optimize the therapy. (B) Breathing with the therapy off compared with the therapy on. (C) Comparison of normal inspiration with CSA therapies.

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  Figure 7. Hepatic denervation, Metavention. (A) Nerves surrounding the common hepatic artery (CHA). (B) Radiofrequency energy is passed through the vessel walls to disrupt sympathetic nerves leading to the liver.