Antiarrhythmic effects of baroreceptor activation therapy in chronic heart failure: a case report.

Background: Autonomic imbalance represents a keystone of chronic heart failure (HF) with substantial clinical and prognostic implications. Baroreceptor activation therapy (BAT) is a new therapeutic strategy to target the autonomic dysbalance by electrical stimulation of carotid baroreceptors. Besides its known beneficial effects on HF parameters, BAT is also supposed to trigger potential antiarrhythmic effects, which may additionally contribute to HF improvement. Case summary: We report on a 70-year-old male with progredient shortness of breath and advanced HF in the context of an extensive cardiovascular history. After optimization of pharmacologic and device-related therapy, the decision was made to implant a BAT system (Barostim Neo, CVRx) to improve functional cardiac parameters and support symptomatic improvement. Implantation was associated with an overall clinical improvement assessed during outpatient visits every 6 months. Frequency of ventricular arrhythmic events declined, and atrial fibrillation ceased spontaneously. Echocardiography revealed an amelioration in left ventricular systolic function. Numbers of HF hospitalization decreased after Barostim implantation. Discussion: We present a patient with an extensive cardiovascular history and fully exploited pharmacologic and device-related therapy, who showed improvement in New York Heart Association (NYHA) functional classification, left ventricular systolic function, and reduction of arrhythmic events following implantation of the BAT device. This case presents an additional positive potential of BAT for HF patients in terms of reduction of arrhythmia burden. These results should be confirmed by further clinical trials.