Title:Non-pharmacological Modulation of the Autonomic Nervous System for Heart Failure Treatment: Where do We Stand?
VOLUME: 16 ISSUE: 1
Author(s):Costas Tsioufis*, Panayiotis Iliakis, Alexandros Kasiakogias, Dimitrios Konstantinidis, Dragan Lovic, Dimitrios Petras, Michalis Doumas, Eleftherios Tsiamis, Vasilios Papademetriou and Dimitrios Tousoulis
Affiliation:First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Clinic for Internal Disease InterMedica, Hypertension Centre, Nis, Nephrology Department, Hippokration Hospital, Athens, 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Veteran Affairs Medical Center and Georgetown University, Washington, D.C, First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens
Keywords:Sympathetic nervous system, neuromodulation, renal denervation, baroreceptor stimulation, vagal nerve stimulation,
spinal cord stimulation.
Abstract:Introduction: An imbalance in the Autonomic Nervous System (ANS) is a central pathophysiologic
mechanism in Heart Failure (HF) and has been a principal target of treatment in these patients.
Traditional pharmacologic agents do not provide specific modulation of discrete arms of the ANS, while
side effects may lead to poor tolerance. Technological advances have provided a series of invasive
methods that may provide a focused effect on the ANS in selected patient groups. Renal denervation,
initially targeted for patients with resistant hypertension, has given positive preliminary results in terms
of heart structure and function. Baroreceptor stimulation also has ongoing research with respect to its
efficacy and longer term effects in HF patients. Vagal nerve stimulation and spinal cord stimulation
have limited data but represent novel treatments that target the hard to reach parasympathetic system.
Conclusion: The present review overviews the pathophysiologic basis, current preclinical and clinical
data and future expectations of these promising treatments.
