Updates on Baroreflex Activation Therapy and Vagus Nerve Stimulation for Treatment of Heart Failure With Reduced Ejection Fraction

In the last decade, neuromodulation via baroreflex activation therapy (BAT) and vagus nerve stimulation (VNS) has emerged as an innovative approach for the treatment of heart failure with reduced ejection fraction (HFrEF). A review of the literature was conducted to examine the latest efficacy and safety data on neuromodulation for the treatment of HFrEF. Two independent researchers searched the PubMed, clinicaltrials.org, and the Cochrane databases for the most recent data on BAT and VNS published between 2013 and 2019. A total of nine studies were identified. BAT and VNS therapy consistently improved subjective heart failure parameters including New York Heart Association class and Minnesota Living with Heart Failure Questionnaire. Improvements in objective cardiac parameters such as left ventricular ejection fraction (LVEF) were less consistently seen; however, where present, ranged from +3% to +6%, in line with improvements seen after other guideline directed therapy such as left ventricular assist device (LVAD). Benefits of BAT showed a predilection for patients without cardiac resynchronization therapy (CRT) and efficacy of VNS therapy varied with device type. The clinical application of BAT and VNS was found to be limited due to low-powered data, inconsistencies in study design, short-term follow-up and lack of diversity in patient recruitment. Well-powered studies with consistent design, longer follow-up and diverse populations are warranted before BAT and VNS can be incorporated into heart failure guidelines and clinical practice.