The authors hoped that these findings as well as preliminary observations suggesting cardiovascular and renal organ protection with electrical carotid sinus stimulation will be confirmed in properly controlled clinical trials. Kuck KH, Bordachar P, Borggrefe M, et al. As elevated BP now is defined as a systolic BP of above 120 mmHg, the prevalence of hypertension in the U.S. has increased from 32 % (old definition of hypertension) to 46 %. Carotid sinus reflex death. list-style-type: lower-roman; Vienna, Austria; Ludwig Boltzmann Institute for Health Technology Assessment; 2018. Electrical carotid sinus stimulators engaging baroreflex afferent activity have been developed for such patients. A specific subgroup of patients, those with indication for a 2-chamber cardiac pacemaker, may benefit from a new stimulation paradigm which reduces the atrioventricular (AV) latency and thus limits the filling time of the left ventricle. Kidney Int. The authors concluded that in this patient cohort, unilateral unipolar electric baroreflex stimulation acutely lowered BP. Or Sign up/login to Reverso account Kollaboratives Wörterbuch Englisch-Französisch. Jordan et al (2012) noted that recently, a novel implantable device was developed that produces an electrical field stimulation of the carotid sinus wall. Carotid sinus stimulators produce an electrical field stimulation of the carotid sinus wall, presumably activating carotid baroreceptors. In a subset (n = 6) of patients with prior renal nerve ablation, arterial BP decreased by 22.3 +/- 9.8 mm Hg. Carotid sinus nerve (CSN) denervation has been shown to improve glucose homeostasis in insulin-resistant and glucose-intolerant rats; however, these positive effects from surgery appear to diminish over time and are heavily caveated by the severe adverse effects associated with permanent loss of chemosensory function. /* aetna.com standards styles for templates */ Jordan J. Device-based approaches for the treatment of arterial hypertension. 2010;56(15):1254-1258. } 2007;33(4):414-421. Arterial baroreceptors in the management of systemic hypertension. The Institute for Clinical Systems Improvement's clinical practice guideline on "Heart failure in adults" (ICSI, 2011) did not mention the use of BAT. Recent advances in technology permitted the development of a new device (Rheos) that addresses problems with older devices. width: 100%; Carotid sinus stimulation synonyms, Carotid sinus stimulation pronunciation, Carotid sinus stimulation translation, English dictionary definition of Carotid sinus stimulation. Sanchez LA, Illig K, Levy M, et al. Electrical field stimulation of the carotid sinus, known as carotid baroreflex activation therapy, holds promise as a novel device-based intervention to supplement, but not replace, drug therapy for patients with resistant hypertension. For additional language assistance: Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming and repositioning, when performed), Implantation or replacement of carotid sinus baroreflex activation device; lead only (includes intra-operative interrogation, programming and repositioning, when performed), Implantation or replacement of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming and repositioning, when performed), Revision or removal of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming and repositioning, when performed), Revision or removal of carotid sinus baroreflex activation device; lead only (includes intra-operative interrogation, programming and repositioning, when performed), Revision or removal of carotid sinus baroreflex activation device; pulse generator only (includes intra-operative interrogation, programming and repositioning, when performed), Interrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric iterative communications with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst node, therapy start/stop times each day), Interrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric iterative communications with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst node, therapy start/stop times each day) with programming, Generator, neurostimulator (implantable), non-rechargeable with carotid sinus baroreceptor stimulation lead(s). They noted that larger randomized, controlled trials are ongoing to verify chronic benefits. This post-market phase will be achieved when 320 mortal and morbid events have occurred. The second-generation device utilizes smaller unilateral unipolar electrodes, thus decreasing invasiveness of the implantation while saving battery. The authors concluded that the findings of the current study demonstrated that MSCS treatment can lower the arterial pressure in normotensive rabbits. Chronic baroreflex activation: A potential therapeutic approach to heart failure with preserved ejection fraction. J Card Fail. Heart failure hospitalization and cardiovascular mortality rates will be examined in the post-market phase of BeAT-HF. Doumas M, Guo D, Papademetriou V. Carotid baroreceptor stimulation as a therapeutic target in hypertension and other cardiovascular conditions. Baroreflex activation therapy was equally effective in reducing ambulatory BP in all subgroups of patients. Moreover, these studies showed that the treatment success may depend on the underlying pathophysiology of the hypertension. The mean procedure time was 198 minutes. Effectiveness end-points were the change from baseline to 6 months in 6-min hall walk distance (6MHW), Minnesota Living with HF Questionnaire quality-of-life (QOL) score, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. color: blue Baseline mean BP was 179/105 mm Hg and HR was 80 beats/min, with a median of 5 anti-hypertensive drugs. Several investigators have suggested that stimulation of the carotid sinus baroreceptors has a reflex negative ino-tropic effect directly upon cardiac perform- ance.1"5 The work of Sarnoff and co-workers ° has adduced substantial evidence for this concept. They concluded that additional clinical trials are needed to ascertain the effectiveness of electrical carotid sinus stimulation in treatment resistant arterial hypertension. Curr Hypertens Rep. 2010;12(3):176-181. Electrical carotid sinus stimulation in treatment resistant arterial hypertension. These investigators reported on the first 17 patients enrolled in a multi-center study. 2006;44(6):1213-1218. Due to their invasiveness, such therapeutic options must prove superiority over conventional therapies with regard to safety and efficacy before they could be generally offered to a wider patient population. The CSLs are placed on the carotid arteries and run subcutaneously to the pulse generator (Note: the procedure does not involve carotid dissection). Research needs in the area of device-related treatments for hypertension. Several questions remain to be addressed before Rheos can be used widely, and several potential clinical applications remain to be clarified. Device-based therapy for hypertension. In the past years, device- and implant-mediated therapies have evolved and extensively studied in various patient populations. Gierthmuehlen M, Plachta DTT, Zentner J. Implant-mediated therapy of arterial hypertension. color: blue!important; Last Review Measurements were performed under resting conditions, with and without electric baroreflex stimulation, for greater than or equal to 6 minutes during the same experiment. J Cardiovasc Transl Res. During control conditions, carotid sinus stimulation induced a significant decrease in arterial pressure and heart rate. OL OL OL OL LI { 2009;13(4):413-425. Heusser K, Tank J, Brinkmann J, et al. Sino-aortic denervation and plasma hormone level analyses were performed. Copyright Aetna Inc. All rights reserved. color: red!important; [ … This result was sustained in 17 subjects who completed 2 years of follow-up, with a mean reduction of 33/22 mm Hg. Conf Proc IEEE Eng Med Biol Soc. 2 Anatomie Die Gefäßwand des Sinus caroticus enthält Barorezeptoren, die vom Ramus sinus carotici des Nervus glossopharyngeus innerviert werden. Electrical stimulation of the carotid sinus baroreflex system has been shown to produce significant chronic blood pressure decreases in animals. Lovett EG, Schafer J, Kaufman CL. Med Sci Monit. Auton Neurosci. They stated that clinical studies and large-scale clinical trials are presently ongoing with the aim of defining the long-term safety and effectiveness of the 2 interventions. The authors concluded that BAT delivered with the second-generation system significantly lowers BP in resistant hypertension with stable, intensive background medical therapy, consistent with studies of the 1st-generation system for electrical activation of the baroreflex, and provides a safety profile comparable to a pace-maker. The programmer system provides the ability to communicate non-invasively with the IPG after implantation to modulate the frequency and intensity of ES. Bloomington, MN: Institute for Clinical Systems Improvement (ICSI); August 2011. Moreover, these researchers noted that it is important to find ways to better identify patients who are most likely to benefit from electrical carotid sinus stimulation. Zhang and colleagues (2017) evaluated the effectiveness of magnetic stimulation of carotid sinus (MSCS), a non-invasive strategy, for lowering BP in rabbits; MSCS with graded intensities and frequencies were systematically attempted in normotensive rabbits; BP was recorded dynamically. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the 1st generation Rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. 2009;2009:4626-4630. The arterial baroreflex regulates mean arterial pressure by responding automatically to changes in cardiac output and vessel tone via baroreceptors, which monitor arterial pressure by gauging the degree of stretch in vessel walls. In a prospective, non-randomized, feasibility study, Scheffers et al (2010) examined the safety and efficacy of Rheos therapy in drug-resistant hypertension patients. From a baseline of 171.7 +/- 20.2/99.5 +/- 13.9 mm Hg, arterial BP decreased by 26.0 +/- 4.4/12.4 +/- 2.5 mm Hg at 6 months. Kougias et al (2010) stated that a model of ES of the carotid sinus has been developed and successfully tested in animals. Minimally invasive system for baroreflex activation therapy chronically lowers blood pressure with pacemaker-like safety profile: Results from the Barostim neo trial. Victor (2015) noted that arterial baroreceptors are mechano-sensitive sensory nerve endings in the walls of the carotid sinuses and aortic arch that buffer the increases and decreases in arterial BP. The enthusiasm for this modality has led to ongoing studies, which will provide more information on its safety and effectiveness in patients with drug-resistant hypertension. OL OL OL OL OL LI { The authors concluded that the current data suggested that the CSLs used with the Rheos System are not associated with the development of carotid stenosis or injury. } Cardiol Rev. 2009;2(2):150-153. Aetna considers implantable carotid sinus stimulators (e.g., the Barostim neo™ System, and the Rheos Baroreflex Hypertension Therapy System) experimental and investigational for the treatment of hypertension and for all other indications (e.g., heart failure) because its effectiveness has not been established. 2017;35(8):1676-1684. Carotid sinus hypersensitivity (CSH) is an exaggerated response to carotid sinus baroreceptor stimulation. OL OL LI { The blood pressure decrease mainly reflected a reduction in cardiac output, total peripheral vascular resistance being essentially unchanged. } } Remuneration for these treatments is guaranteed in many countries even though basic information is missing. Illig KA, Levy M, Sanchez L, et al. carotid sinus stimulation does not change ex vivo vascular reactivity to the alpha-adrenoreceptor agonist phenylephrine. There were no adverse events attributable to the device. Carotid sinus reflex death is a potential etiology of sudden death in which manual stimulation of the carotid sinus allegedly causes strong glossopharyngeal nerve (Vagus nerve is for aortic arch baroreceptors) impulses leading to terminal cardiac arrest. Subjects received either BAT (group A) for the first 6 months or delayed BAT initiation following the 6-month visit (group B). } A total of 30 patients enrolled from 7 medical centers in Europe and Canada. Georgakopoulos et al (2011) stated that heart failure with preserved ejection fraction (HFpEF) is a substantial public health issue, equal in magnitude to heart failure with reduced ejection fraction. 2014;2(3):118-122. Kougias P, Weakley SM, Yao Q, et al. by which electric carotid sinus field stimulation affects blood pressure in human subjects are unknown. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. OL OL OL LI { By observing and recording how the blood pressure of a patient and other symptoms change during stimulation, doctors can determine the seriousness of the condition. In the BAT group versus the control group, QOL score decreased (Δ = -14.1; 95 % confidence interval [CI]: -19 to -9; p < 0.001), 6MHW distance increased (Δ = 60 m; 95 % CI: 40 to 80 m; p < 0.001), NT-proBNP decreased (Δ = -25 %; 95 % CI: -38 % to -9 %; p = 0.004), and the MANCE-free rate was 97 % (95 % CI: 93 % to 100 %; p < 0.001). Baroreflex stimulation in antihypertensive treatment. Smaller coils of 50 mm diameters have been used in rats for research. https://medical-dictionary.thefreedictionary.com/Carotid+sinus+stimulation. Ovine carotid angiography revealed no significant stenoses, while anatomical and histological evaluations demonstrated electrode encapsulation in a thin layer of connective tissue with no evidence of stenosis, erosion, or inflammation. Following the vagal response to carotid sinus nerve stimulation a period of inhibition of vagal activity, lasting 100-150ms, occurred. } Subjects were followed-up for as long as 2 years. It’s easy and only takes a few seconds. This latter peculiarity has implemented the research for new approaches to the treatment of the disease. text-decoration: underline; } A total of 45 subjects with SBP greater than or equal to 160 mm Hg or DBP greater than or equal to 90 mm Hg despite at least 3 anti-hypertensive drugs were enrolled in this study. The depressor response was correlated with a muscle sympathetic nerve activity reduction (r(2) = 0.42; p < 0.05). Taylor JG, Bisognano JD. See also carotid sinus syndrome. Baroreflexes are one of many control systems acting in concert. Overview of the management of heart failure with reduced ejection fraction in adults. .fixedHeaderWrap { Electric stimulation of the baroreceptor fibers located in the carotid sinus leads to decreased sympathetic nerve activity and increased vagal tone. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. .newText { stimulation of the carotid sinus baroreceptors on atrial and ventricular dynamics are the subject of controversy. We evaluated the effects of long-term (48 h) electrical stimulation of the carotid sinus (CS) in hypertensive rats. Electrical carotid sinus stimulation: Chances and challenges in the management of treatment resistant arterial hypertension. All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. Doumas et al (2009) stated that the role of the carotid baroreflex in BP regulation has been known for a long time but its effects were thought to be short-lived. .strikeThrough { The utility of VNS awaits appropriate assessment. When the baroreceptors are stimulated this causes slowing of the heart rate, vasodilation (widening of … background: #5e9732; list-style-type: decimal; Ng and colleagues (2011) noted that the Rheos Baroreflex Hypertension Therapy System is a new implantable device that can treat patients with hypertension resistant to multi-drug therapy, by activating the carotid baroreflex through ES of the carotid sinus wall. 62 As a result, baroreceptor activation therapy (BAT) has been investigated as a novel treatment strategy in HF … The authors concluded that this was the first study demonstrating a significant BP reduction in ABPM in patients undergoing chronically stimulation of the carotid sinus using the BAT neo device. Baroreflex activation therapy in patients with heart failure with reduced ejection fraction. Recent data indicate that stimulation of carotid baroreceptors may lower BP not only for short periods of time, but also in the long run. 2012;6(4):270-276. Dictionary, Encyclopedia and Thesaurus - The Free Dictionary, the webmaster's page for free fun content, carotid branch of glossopharyngeal nerve (CN IX), Carotid Sinus Nerve Chemosensory Discharge, Carotid Stump Pressure/mean Arterial Pressure Index. Background medical therapy for hypertension was unchanged during follow-up. Lohmeier and Iliescu (2011) summarized the pre-clinical studies that have provided insight into the mechanisms that account for the chronic BP-lowering effects of carotid baroreflex activation. Intra-arterial BP was 193 +/- 9/94 +/- 5 mm Hg on medications. Translations in context of "carotid sinus stimulation" in English-French from Reverso Context: }. Electrical stimulation (ES) of the carotid sinus has been shown to lowers blood pressure (BP) by activating the baroreflex and thereby reducing sympathetic tone. /*margin-bottom: 43px;*/ This Clinical Policy Bulletin may be updated and therefore is subject to change. Carotid sinus nerve stimulation: studies on the mechanism of the hypotensive response. } The study by Domingos-Souza et al. However, long-term results are not yet available for this therapeutic option. Carotid sinus stimulation. However, it did not meet the endpoints for acute responders or procedural safety. The spectrum of therapeutic impact suggests that Rheos therapy may improve long-term outcomes in drug-resistant hypertension and possibly benefit related populations. Previously, we reported that magnetic stimulation of carotid sinus (MSCS) could lower arterial pressure in rabbits. Furthermore, an UpToDate review on "Overview of the management of heart failure with reduced ejection fraction in adults" (Colucci, 2020) does not mention implantable carotid sinus stimulator as a management / therapeutic option. The safety end-point included the major adverse neurological or cardiovascular system or procedure-related event rate (MANCE). Moreover, they stated that randomized controlled trials (RCTs) are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately. 2014;16(1):109-128. .newText { The authors stated that clinical studies suggested that electrical carotid sinus stimulation attenuates sympathetic activation of vasculature, heart, and kidney while augmenting cardiac vagal regulation, thus lowering BP; however, not all patients respond to treatment. 2020;76(1):1-13. J Am Soc Hypertens. At least three-second asystole (cardio-inhibition - the most common form; 70-75% of cases). Vagal nerve stimulation, a more recent technique, employs pacemaker stimulation of the vagus as a treatment for refractory epilepsy. In a phase II clinical trial, Illig et al (2006) evaluated the response of patients with multidrug-resistant hypertension to ES of the carotid sinus via an implantable device. Tordoir JH, Scheffers I, Schmidli J, et al. A total of 29 CSLs were implanted on the common carotid arteries of 8 sheep. Clinical outcomes of HFpEF patients are generally poor, and no therapy has been shown to be effective in randomized clinical trials. Effects of baroreflex activation therapy on ambulatory blood pressure in patients with resistant hypertension. Remarkably, carotid sinus stimulation selectively improved endothelium-dependent acetylcholine-induced vasodilation ex vivo while endothelial nitric oxide synthase protein expression or phosphorylation did not change. The GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial suggested that reduction in NT-proBNP from greater than 1,000 to less than 1,000 pg/ml was associated with a significant improvement in LV systolic function (increased EF) and LV re-modeling (reduced LV end-diastolic volume). Electrical stimulation of carotid sinus baroreflex afferents acutely decreased arterial BP in hypertensive patients, without negative effects on physiological baroreflex regulation. The device exhibited a favorable safety profile. Portable, wearable, or wireless devices for magnetic brain stimulation are under‐developing. Without stimulation, BP was 165 ± 31/91 ± 18 mm Hg, HR was 75 ± 17 bpm, and MSNA was 48 ± 14 bursts/min. #closethis { Curr Hypertens Rep. 2020;22(2):16. The findings of this small open-label study need to be validated by well-designed studies. Ann Biomed Eng. The post-market phase is intended to expand the indication of use to reduction of HF hospitalizations and cardiovascular mortality.

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