Barostim for HFrEF in the Electrophysiologist’s Toolbox: HRS 2023

In our symposium at HRS 2023, esteemed faculty Drs. Jagmeet Singh, David Kenigsberg, Rizwan Alimohammad, and Anne Kroman share their experiences treating HFrEF patients with Barostim. Watch the videos below to hear how Barostim is improving exercise capacity for heart failure patients when guideline directed medical therapy (GDMT) isn’t enough.


Unmet Needs and Device Therapies in HFrEF
Jagmeet Singh, MD, PhD

 

 

In his presentation, Dr. Singh reviews the results of the BeAT-HF trial which compared patients treated with Barostim therapy to those receiving the standard of care. He also discusses how heart failure can be recognized as a gradual decline, with a series of improvements that eventually return to a downward trajectory. In elaborating that GDMT can increase a patient’s life expectancy, he notes that often, this is not enough for many patients. “Even though drugs end up enhancing long-term outcomes, they don’t enhance your physical activity, your effort tolerance.” In discussing the need for improvement in this area, Dr. Singh explains that Barostim is an option that increases exercise capacity significantly when compared to patients who are treated with GDMT alone. “There’s a totality of evidence that indicates Baroreflex Activation Therapy [Barostim] is a safe, effective and durable treatment for patients with heart failure with reduced ejection fraction”.

 

Device Options for HFrEF
David Kenigsberg, MD

 

Dr. Kenigsberg shares his perspective on heart failure symptom treatment options and how his primary incentive is to help patients improve their quality of life. In discussing Barostim, Dr. Kenigsberg says: “If you look at a heart failure patient, and you talk to them, you see where they’re at. I don’t know that they care so much about mortality. But they definitely care about how they feel. And they are definitely looking to you, looking in your eyes, and asking you to help them feel better. That’s why I think Barostim, for me, has made such an impression.” Dr. Kenigsberg goes on to discuss CRT data, and what can be used to supplement GDMT treatment. Detailing his experience with implantable devices, Dr. Kenigsberg explains that Barostim, used in tandem with GDMT, has a direct improvement on a patient’s 6MHW, quality of life, and NYHA class.

 

Barostim in the EP’s HFrEF Toolbox
Rizwan Alimohammad, MD

 

Dr. Alimohammad shares his experience and best practices of referring more than 17 patients to Barostim. He has seen many patients frustrated with their heart failure symptoms, people who are eager for another option, “If they are still having symptoms, despite being on GDMT, these are the patients that should have a conversation with us about Barostim.” He goes on to discuss the trajectory of CRT non-responders who keep experiencing exacerbations. After a consult, some of these non-responders will get Barostim, and the exacerbations stop. “These are precisely the patients that have CRT implanted, they have optimized their medications, they’ve done everything possible. These are the patients that should talk to us about Barostim.”

 

What’s Next for Baroreflex Activation Therapy?
Anne Kroman, DO, PhD

 

Dr. Kroman discusses her experience with the BATwire Implant Kit Study which is investigating the safety and effectiveness of a new implant approach - allowing the procedure to be conducted in an EP cath lab setting, as opposed to a fully staffed OR. “The hope is that this will be an easy transition to having [Barostim] become a more regular device in our EP lab, with patients home the same day… I think it will help us provide better access to this device, to a larger patient population who would truly benefit from [Barostim] and this physiology.”

CAUTION: Investigational device.  Limited by Federal (or United States) law to investigational use.
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Important Safety Information

CAUTION: Federal law restricts this device to sale by or on the order of a physician. See Instructions for Use 900133-001 for a complete instruction for use and a description of indications, contraindications, warnings, precautions and adverse events.

Barostim™ Brief Summary for Physicians

The Barostim System is indicated for the improvement of symptoms of heart failure—quality of life, six-minute hall walk and functional status—for patients who remain symptomatic despite treatment with guideline-directed medical therapy, are NYHA Class III or Class II (who had a recent history of Class III), have a left ventricular ejection fraction ≤ 35%, a NT-proBNP < 1600 pg/ml and excluding patients indicated for Cardiac Resynchronization Therapy (CRT) according to AHA/ACC/ESC guidelines.

Patients are contraindicated if they have been assessed to have bilateral carotid bifurcations located above the level of the mandible, baroreflex failure or autonomic neuropathy, uncontrolled symptomatic cardiac bradyarrhythmias, carotid atherosclerosis that is determined by ultrasound or angiographic evaluation greater than 50%, ulcerative plaques in the carotid artery as determined by ultrasound or angiographic evaluation, known allergy to silicone or titanium.

Warnings include:  only trained physicians may use this system, prescribing physicians should be experienced in the diagnosis and treatment of heart failure and should be familiar with the use of this system, monitor blood pressure and heart rate during Carotid Sinus Lead placement and when adjusting stimulation parameters intra-operatively, post-implantation, program the system to avoid the following:  heart rate falls below 50 beats per minute (BPM), or systolic pressure falls below 90 mmHg, or diastolic blood pressure falls below 50 mmHg, or problematic adjacent tissue stimulation is noted, or undesirable interaction indicated by monitoring of any other implanted electrical device (see “Device Interaction Testing” in Section 10), or any other potentially hazardous patient responses are observed.  Improper system implantation could result in serious injury or death. Do not use diathermy therapy including shortwave, microwave, or therapeutic ultrasound diathermy on patients implanted with the system.  Patients should be counseled to stay at least 15 cm (6 inches) away from devices with strong electrical or magnetic fields such as strong magnets, loudspeaker magnets, Electronic Article Surveillance (EAS) system tag deactivators, arc welders, induction furnaces, and other similar electrical or electromechanical devices.  This would include not placing items such as earphones in close proximity to the implanted pulse generator.  The IPG may affect the operation of other implanted devices such as cardiac defibrillators, pacemakers, or neurological stimulation systems. For patients who currently have an implanted electrical medical device, physicians must verify compatibility with the implanted device during implantation of the system. Contralateral implant of the Barostim NEO IPG may help to reduce potential interactions. Interactions are more likely in devices that contain a sensing function, such as an implantable cardiac defibrillator or pacemaker.  If an interaction is observed, the Barostim NEO IPG should be programmed to reduced therapy output settings in order to eliminate the interaction.  If necessary, change settings in the other implant only if the changes are not expected to negatively impact its ability to perform its prescribed therapy.  During the implant procedure, if device interactions cannot be eliminated the Barostim NEO System should not be implanted. 

Precautions include: the system should be implanted and programmed carefully to avoid stimulation of tissues near the electrode or in the area of the IPG pocket.  Such extraneous stimulation could involve the following: the regional nerves, causing laryngeal irritation, difficulty swallowing, or dyspnea, the cervical musculature, causing intermittent contraction, skeletal muscles, causing intermittent contraction around the IPG pocket.  Proper sterile technique during implantation should be practiced and aggressive pre-operative antibiotics are recommended.  Infections related to any implanted device are difficult to treat and may necessitate device explanation.

It is anticipated that subjects will be exposed to operative and post-operative risks similar to related surgical procedures involving the neck and/or a pacemaker implant.  These risks and potential risks of chronic device based baroreflex activation may include, but are not limited to:  stroke, transient ischemic attack (TIA), systemic embolization, surgical or anesthetic complications, infection, wound complications, arterial damage, pain, nerve damage/stimulation, hypotension, hypertensive crisis, respiratory, exacerbation of heart failure, cardiac arrhythmias, tissue erosion/IPG migration, injury to baroreceptors, fibrosis, allergic reaction, general injury to user or patient, need for reoperation, secondary operative procedure, and death.  Patients implanted with the system may receive Magnetic Resonance Imaging (MRI) only when all MR Conditional safety parameters are met as listed in the instructions for use.

For a list of all potential benefits and risks go to www.cvrx.com/benefit-risk-analysis/