Baroreflex activation therapy through electrical carotid sinus stimulation

IF 3.2 4区医学 Q2 NEUROSCIENCES

Autonomic Neuroscience-Basic & Clinical Pub Date : 2024-11-13 DOI:10.1016/j.autneu.2024.103219

Jens Jordan , Jens Tank , Karsten Heusser , Hannes Reuter

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引用次数: 0

Abstract

An imbalance between cardiovascular parasympathetic and sympathetic activity towards sympathetic predominance has been implicated in the pathogenesis of treatment-resistant arterial hypertension and heart failure. Arterial baroreceptors control efferent cardiovascular autonomic activity and have, therefore, been recognized as potential treatment targets. Baroreflex activation therapy through electrical carotid sinus stimulation is a device-based approach to modulate cardiovascular autonomic activity. Electrical carotid sinus stimulation lowered blood pressure in various hypertensive animal models and improved cardiac remodeling and survival in preclinical models of heart failure. In human mechanistic profiling studies, electrical carotid sinus stimulation lowered blood pressure through sympathetic inhibition with substantial inter-individual variability. The first-generation device reduced blood pressure in controlled and uncontrolled clinical trials. Controlled clinical trials proving efficacy in blood pressure reduction in patients with hypertension do not exist for the currently available second-generation carotid sinus stimulator. Investigations in heart failure patients showed improved symptoms, quality of life, and natriuretic peptide biomarkers. Electrical carotid sinus stimulation is an interesting technology to modulate cardiovascular autonomic control. However, controlled trials with hard clinical endpoints are required.

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通过颈动脉窦电刺激激活巴反射疗法。

心血管副交感神经和交感神经活动失衡，交感神经占主导地位，这与治疗耐受性动脉高血压和心力衰竭的发病机制有关。动脉气压感受器控制着心血管自主神经的传出活动，因此被认为是潜在的治疗目标。通过颈动脉窦电刺激激活巴反射疗法是一种基于设备的调节心血管自律神经活动的方法。颈动脉窦电刺激可降低各种高血压动物模型的血压，改善心衰临床前模型的心脏重塑和存活率。在人体机理分析研究中，颈动脉窦电刺激可通过抑制交感神经降低血压，但个体间差异很大。在对照和非对照临床试验中，第一代设备降低了血压。目前市场上的第二代颈动脉窦刺激器还没有证明对高血压患者有降压疗效的对照临床试验。对心力衰竭患者进行的调查显示，患者的症状、生活质量和钠尿肽生物标志物均有所改善。颈动脉窦电刺激是一种调节心血管自律神经控制的有趣技术。不过，还需要进行具有硬性临床终点的对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Autonomic Neuroscience-Basic & Clinical 医学-神经科学

CiteScore

5.80

自引率

7.40%

发文量

审稿时长

66 days

期刊介绍： This is an international journal with broad coverage of all aspects of the autonomic nervous system in man and animals. The main areas of interest include the innervation of blood vessels and viscera, autonomic ganglia, efferent and afferent autonomic pathways, and autonomic nuclei and pathways in the central nervous system. The Editors will consider papers that deal with any aspect of the autonomic nervous system, including structure, physiology, pharmacology, biochemistry, development, evolution, ageing, behavioural aspects, integrative role and influence on emotional and physical states of the body. Interdisciplinary studies will be encouraged. Studies dealing with human pathology will be also welcome.