Ambulatory hemodynamic changes following baroreflex activation therapy measured by an implantable pulmonary artery pressure sensor

Baroreflex activation therapy (BAT) is a device-based treatment option for patients with heart failure and reduced ejection fraction that has the potential to favorably modulate cardiac hemodynamics. Implantable pulmonary artery (PA) pressure sensors enable longitudinal assessment of ambulatory hemodynamic changes, providing a unique opportunity to characterize physiologic responses associated with BAT in real-world clinical settings. A 76-year-old male with a history of ischemic cardiomyopathy, ventricular tachycardia, atrial fibrillation, and chronic kidney disease underwent implantation of a PA pressure sensor followed by implantation of BAT. Prior to BAT, daily PA diastolic pressure (PADP) values fluctuated around 20 mmHg. After initiation of BAT and subsequent dose titration, PADP progressively decreased and stabilized at approximately 15 mmHg. This hemodynamic improvement was accompanied by a reduction in diuretic utilization. Decongestion, reflected by sustained reductions in PADP and a reduced need for loop diuretics, suggests more effective intrinsic volume regulation. Together, PADP reduction and diuretic de-escalation may represent complementary mechanisms through which BAT-mediated neurohormonal modulation translates into clinically meaningful symptomatic benefit. Learning objective Implantable hemodynamic monitoring enables timely optimization of background therapy and longitudinal characterization of therapeutic responses in heart failure patients. This case highlights decongestion and favorable hemodynamic remodeling associated with baroreflex activation therapy (BAT) and underscores the value of integrating BAT with remote hemodynamic monitoring to individualize heart failure therapy.