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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EBaroreceptor activation therapy improves quality of life, exercise capacity, and potentially the burden of heart failure hospitalizations in patients with functional class III heart failure with reduced ejection fraction who are on optimal medical and\/or device therapy, with pronounced benefit in patients who are not treated with cardiac resynchronization therapy.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ebaroreceptor activation therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ereduced ejection fraction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiac resynchronization therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Edevice therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EBaroreflex activation therapy (BAT) improved quality of life and exercise capacity in patients with heart failure and reduced ejection fraction, with a more pronounced impact in patients who had not undergone cardiac resynchronization therapy (CRT). Data from a randomized, phase 2 trial of BAT were presented by Michael Zile, MD, Medical University of South Carolina, Charleston, South Carolina, USA.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBAT acts through a central integrated mechanism to both decrease sympathetic tone and increase parasympathetic tone, rebalancing the autonomic imbalance present in patients with heart failure, explained Dr Zile. The procedure involves surgically implanting a 2 mm lead at the coronary sinus and connecting it to a pulse generator, which is placed in the subcutaneous space. Initial studies demonstrated a positive effect of carotid baroreceptor stimulation on ventricular remodeling, vasodilation, and renal function [Abraham WT et al. \u003Cem\u003EJACC Heart Fail\u003C\/em\u003E. 2015]. Whether the positive response to BAT is uniform across all patients, particularly those who receive guideline-directed medical therapy, is not known.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the prospective multinational trial, 140 patients with NYHA functional class III heart failure were randomized 1:1 to optimal medical and device therapy alone (control group) or BAT plus optimal medical and device therapy. To be eligible, patients had to have a left ventricular ejection fraction \u2264\u200535% and a 6-minute hall walk distance of 150 to 400 m. They had to be on stable medical therapy for at least 4 weeks prior to baseline assessment and, if indicated, device therapy for at least 6 months. Of the 140 patients, 45 had undergone CRT.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary safety end point was system- or procedure-related major adverse neurological or cardiovascular events at 6 months; the event-free rates were 100% in the CRT group and 96% in the no-CRT group, attesting to the safety of BAT.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn patients without CRT, the Minnesota Living with Heart Failure Quality of Life score improved by 21.6 points from baseline to 6 months in the BAT group, compared with a 3.5-point decrement in the control group (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.001). In patients with CRT, there was no significant difference in this score between the BAT group and controls (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.23). The difference in response to BAT between the CRT and no-CRT groups was statistically significant (\u003Cem\u003EP-\u003C\/em\u003Einteraction\u2005=\u2005.04).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EIn patients without CRT, 6-minute walk distance improved by 85.5 m in the BAT group vs a 3.6-m improvement in the controls (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.003). No such difference between the BAT groups and controls emerged in the CRT patients (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.38). Again, the difference in response to BAT on this end point between the CRT and no-CRT groups was significant (\u003Cem\u003EP-\u003C\/em\u003Einteraction\u2005=\u2005.01).\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ELeft ventricular ejection fraction, an exploratory end point, improved significantly from baseline to 6 months in the no-CRT patients who received BAT vs controls (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.03), with no such difference in the CRT group (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.71). The difference in response to BAT between the CRT and no-CRT groups was statistically significant (\u003Cem\u003EP-\u003C\/em\u003Einteraction\u2005=\u2005.02).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe observations need to be confirmed in an adequately powered, prospective, randomized clinical outcomes trial, which is scheduled to begin in September 2015, said Dr Zile.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/12\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlj5d\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}