Baroreflex Neuromodulation

  • The autonomic nervous system (ANS) is integral to cardiovascular system function
  • Heart failure (HF) pathophysiology is mediated by autonomic dysfunction with a sustained imbalance of increased sympathetic activity and decreased parasympathetic activity
  • The baroreflex, a key powerful regulator of cardiovascular homeostasis, is a critical consideration in heart failure
  • Baroreflex neuromodulation has a role as an HF therapy

Baroreceptors and Baroreflex Mechanism

Source: La Rovere and Christensen, Vascular Pharmacology, 2015

  • The baroreflex provides a powerful centralized neuromodulation to ANS
    • Maintains normal homeostasis: Inhibition of sympathetic activity and augmentation of parasympathetic drive
    • Therapeutic target to restore natural physiological autonomic adaptation and balance
  • Carotid baroreceptors are mechanoreceptors
    • Located in carotid sinus (more sensitive than the aortic arch receptors)
    • Activated by arterial wall stretch, not pressure
    • Triggers increased signaling to the brain
    • Sustained baroreceptor activation response to pulsatile carotid sinus stretch