Baroreflex activation therapy in heart failure

As a crucial regulator for the maintenance of homeostasis, the baroreflex is one of the most comprehensively studied phenomena of systems physiology. Although initially perceived as a transient mechanism, it has been exploited as both an acute and a chronic therapeutic vector since before the advent of modern medicine. However, various challenges have limited its use. Baroreflex activation therapy (BAT), which evokes the baroreflex through electrical stimulation of the carotid baroreceptors, provides a practical approach for chronic therapy. BAT has been shown to significantly reduce blood pressure (BP) in resistant hypertension patients through restoration of autonomic balance controlling the peripheral circulation. Because heart failure is characterized by a hyperadrenergic state with hemodynamic sequelae similar to hypertension, it has been postulated that BAT may also be a relevant therapy in this setting. It is the purpose of this chapter to review the substantial body of basic science and clinical evidence which supports this contention, with particular emphasis on outcomes.