Devices and intervention in heart failure.

• I have received honoraria and research support from numerous pharmaceutical and device companies.

Eur J of Heart Fail (2014) 16, 796–801

N Eng J Med 2004;351:16:1681-1684

Eur J of Heart Fail (2014) 16, 1223–1229

LV Remodeling Post MI and Heart Failure

• Parachute: Ventricular Restoration– Partitions the damaged muscle and reduces heart

wall stress– Decreases LV volume and restores geometrical

shape– Improves cardiac performance

Speaker

1Jhund and McMurray. Heart Failure After Acute MI. Circulation. 2008;118:2019-2021

2RESTORE Group. JACC 2004, Vol. 44, No. 7.

Eur J of Heart Fail (2014) 16, 1112–1119

Baroreflex Activation Therapy (BAT)Application

• Stimulate bilaterally (2nd gen unilaterally) carotid bodies

Hypothesis: BAT mimics increased BP resulting in inhibition of sympathetic activity and enhanced parasympathetic activity

• Clinical data suggest BAT reduces muscle sympathetic nerve activity and improves HRV

Evidence

Carotid sinusmechanoreceptors

Carotid sinusnerves

Brainstemcardiovascular

centers

Ach Ach

Eur J of Heart Fail (2014) 16, 977–983

Eur J of Heart Fail (2014) 16, 403–408

Eur J of Heart Fail (2014) 16, 1120–1124

Eur J of Heart Fail (2014) 16, 117–118

Eur J of Heart Fail (2015) 17, 135–143

PACE Primary Endpoints

LV e

ject

ion

frac

tion

(%)

*P<0.001 vs. baseline, †P<0.05 vs. 1-year follow-up

Absolute difference of EF by 7%Absolute difference of EF by 7% at 1-year, and at 1-year, and 9.9% at 2-year9.9% at 2-year

RVA pacingRVA pacing

BiV pacing

LV e

nd-s

ysto

lic v

olum

e (m

l)*P<0.001 vs. baseline, †P<0.05 vs. 1-year follow-up

Absolute difference of LVESV by 8.1ml Absolute difference of LVESV by 8.1ml at 1-year, at 1-year, and 13.0 ml at 2-yearand 13.0 ml at 2-year

EF LVESV

Eur J of Heart Fail (2014) 16, 1199–1205

EurJ of Heart Fail (2014) 16, 1323–1330

Eur J of Heart Fail (2014) 16, 802–809

Eur J of Heart Fail (2014) 16, 419–425

Thanks for your attention

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”It is a fact of life that any discourse, onany subject, whatever the occasion andwhatever the status of the speaker, willalways please if it is five minutes shorterthan people expect.”

Paul Johnson

Ventricular Volumes are Strongest Predictors of Survival

% P

atie

nts S

urvi

ving

605 male patients, <60 years old, assessed 1-2 months post-MI and followed for 78 months (mean)

White HD, et al. Circulation 1987;76:44-51.