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Baroreflexaktivierungstherapie

Ein neuer interventioneller Ansatz zur Behandlung der systolischen Herzinsuffizienz

Baroreflex activation therapy

A novel interventional approach to treat heart failure with reduced ejection fraction

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Zusammenfassung

Eine Dysbalance des sympathischen und des parasympathischen Nervensystems trägt entscheidend zur Pathophysiologie der systolischen Herzinsuffizienz bei. Die Baroreflexaktivierungstherapie (BAT), also die elektrische Stimulation der Barorezeptoren im Bereich des Karotissinus, kann den Sympathikotonus reduzieren und den Parasympathikotonus steigern. Experimente im Großtiermodell haben eine Verbesserung der linksventrikulären Funktion, eine Verringerung ventrikulärer Arrhythmien und einen Überlebensvorteil durch die BAT im Vergleich zu nichtbehandelten Kontrolltieren nachgewiesen. Die kürzlich publizierte erste multizentrische, randomisierte und kontrollierte Studie zur BAT bei Patienten mit einer linksventrikulären Ejektionsfraktion von 35 % oder weniger (leitliniengerechte medikamentöse und Device-basierte Therapie allein vs. zusätzliche BAT) hat ein akzeptables Risikoprofil der BAT in diesem schwer kranken Patientenkollektiv gezeigt. Interaktionen mit anderen Devices wurden nicht beobachtet. In der Studie wurden signifikante Verbesserungen der NYHA-Klasse, der Lebensqualität und der 6-Minuten-Gehstrecke nachgewiesen. Außerdem ergaben sich Hinweise auf eine Reduktion der Hospitalisierungsrate. Der NT-proBNP-Spiegel wurde signifikant verringert. Diese Arbeit soll einen Überblick über die BAT in der Behandlung der systolischen Herzinsuffizienz vermitteln, von der Rationale der Therapie und tierexperimentellen Daten bis zu den neuesten klinischen Studien und zukünftigen Perspektiven.

Abstract

Sympathovagal imbalance plays an important role in the progression of heart failure with reduced ejection fraction. Baroreflex activation therapy (BAT), i. e. electrical stimulation of baroreceptors located at the carotid sinus, can reduce sympathetic and enhance parasympathetic tone. Large animal studies on BAT demonstrated improvements in cardiac function, arrhythmogenic risk and a survival benefit compared to untreated controls. The recently published Neo Randomized Heart Failure Study, the first multicenter, randomized and controlled trial of optimal medical and device therapy alone or plus BAT in patients with a left ventricular ejection fraction ≤ 35 %, demonstrated a reasonable safety profile of BAT in this severely ill patient population and no relevant interactions with other devices. The study found significant improvements in the New York Heart Association (NYHA) class of heart failure, quality of life as well as 6 min walking distance and data pointed to a reduction in hospitalization rates. Moreover, N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were significantly reduced. This review gives an overview on BAT for the treatment of heart failure with reduced ejection fraction, from the rationale and animal experiments to the most recent clinical data and future perspectives.

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Authors and Affiliations

  1. Klinik III für Innere Medizin, Herzzentrum, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    M. Halbach, T. Fritz, R. Pfister & H. Reuter

  2. Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Uniklinik Köln, Köln, Deutschland

    N. Madershahian

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  1. M. Halbach
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  2. T. Fritz
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  3. N. Madershahian
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  4. R. Pfister
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  5. H. Reuter
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Correspondence to M. Halbach.

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Interessenkonflikt

M. Halbach, N. Madershahian und H. Reuter sind Prüfärzte in Studien, die von der Firma CVRx gesponsert werden, und haben Vortrags- oder Beratungshonorare erhalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Halbach, M., Fritz, T., Madershahian, N. et al. Baroreflexaktivierungstherapie. Herz 40, 959–965 (2015). https://doi.org/10.1007/s00059-015-4361-9

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  • DOI: https://doi.org/10.1007/s00059-015-4361-9

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