Cardiac Autonomic Nerves Stimulation Improves Hemodynamics: A Pilot Study in Advanced Heart Failure Patients

Abstract

Purpose Despite therapy advances in heart failure management, symptomatic congestion in acute heart failure is a leading cause of mortality and morbidity. An electrode catheter-based technology, cardiac autonomic nerve stimulation (CANS), is being investigated to transvenously stimulate cardiac autonomic nerves to control left-ventricular contractility and heart rate (HR). Methods The study was a single-center, clinical investigation to observe CANS effects on in-hospital hemodynamics and signs and symptoms of congestion. Five subjects with reduced left ventricular ejection fraction (LVEF Results Most subjects were male (3/5), had a mean age of 65 years, mean NT-proBNP of 3622 pg/mL and a mean Pulmonary Capillary Wedge Pressure (PCWP) of 30 mmHg. CANS was provided for a mean of 18 hours and was well tolerated. There were no adverse events reported. Mean LVEF increased in all subjects (27% to 35%) over the stimulation period. In three subjects, CANS directly modulated arterial pulse pressure (12% mean change) with a neutral HR effect ( Conclusion Alongside concomitant medical therapy, CANS directly improved hemodynamics and was associated with improved signs and symptoms of congestion. These improvements, and no adverse events, demonstrate that CANS holds promise as a tool to improve in-hospital hemodynamics and congestion. Future study is warranted to investigate CANS Therapy for longer stimulation duration, in expanded patient phenotypes, in more subjects.