Living with heart failure can mean struggling with shortness of breath, fatigue, and difficulty performing everyday activities. Although medications and other treatments help many people manage these symptoms, some continue to experience limitations despite receiving recommended medical therapy.
“Even with the right medications and other recommended treatments, some people with heart failure continue to experience shortness of breath, fatigue and difficulty completing everyday activities,” said Dr. Brenda Hott, an advanced heart failure cardiologist with Northside Hospital Heart Institute. “For carefully selected patients, Barostim may provide another option to help improve symptoms and quality of life.”
Barostim is an FDA-approved treatment for a select group of heart failure patients.
How Barostim works
Heart failure can disrupt the balance between the nervous system's two branches: sympathetic and parasympathetic.
The sympathetic nervous system activates the body’s “fight-or-flight” response, while the parasympathetic nervous system helps the body rest and recover. In heart failure, sympathetic activity can become overactive while parasympathetic activity is reduced. This imbalance may increase stress on the heart and contribute to symptoms.
Barostim uses Baroreflex Activation Therapy to stimulate baroreceptors, natural pressure sensors in the carotid artery wall in the neck. The device sends gentle electrical impulses to these sensors, helping the brain regulate the body’s cardiovascular response.
“Barostim works differently from a pacemaker or defibrillator because it does not directly stimulate the heart or treat an abnormal heart rhythm,” Dr. Hott said. “Instead, it activates natural pressure sensors in the carotid artery to help reduce some of the stress placed on the heart.”
The therapy is designed to improve functional status, exercise capacity, and quality of life in eligible patients.
Who may be eligible?
Barostim is not intended for every person with heart failure. Potential candidates may include patients who:
- Have a left ventricular ejection fraction of 35% or less.
- Continue to experience significant symptoms despite guideline-directed medical therapy.
- Have a qualifying level of N-terminal pro B-type natriuretic peptide, or NT-proBNP.
- Meet specific New York Heart Association functional classifications.
A complete evaluation is required to determine whether the treatment is appropriate. Physicians may review the patient’s medical history, symptoms, medications, heart function, and previous treatments. Testing may include an echocardiogram, electrocardiogram, blood tests and an ultrasound of the carotid arteries.
“Heart failure treatment is not one-size-fits-all,” Dr. Hott said. “Our goal is to understand how heart failure affects each patient’s daily life and determine which combination of treatments offers the best opportunity to help them feel and function better.”
What to expect during implantation
The Barostim system includes a battery-powered pulse generator implanted beneath the skin near the collarbone. A lead connects the generator to an electrode placed on the outside of the carotid artery. No part of the system is placed inside the heart or blood vessels.
At Northside Hospital, heart failure specialists work closely with vascular surgeons experienced in implanting the device.
“We work closely with our heart failure team colleagues to identify appropriate Barostim candidates and ensure seamless care throughout the process,” said Dr. Siddharth Patel, a board-certified vascular surgeon and medical director of Northside Hospital’s vascular program. “Patients remain symptomatic despite being on guideline-directed medical therapy and meet established criteria, including NYHA Class III, Class II with recent Class III symptoms, reduced ejection fraction, and acceptable biomarker levels.”
During the procedure, the vascular surgeon accesses the carotid artery and maps the carotid sinus to identify the optimal lead location.
“As the implanting vascular surgeon, I perform the carotid exposure, map the carotid sinus to identify the optimal lead position, and complete the implant in a minimally invasive fashion, typically in under an hour and on an outpatient basis,” Dr. Patel said. “This multidisciplinary approach is designed to help improve patients’ symptoms, exercise tolerance, and overall quality of life.”
Patients typically can return home the same day, although recovery times may vary.
Life after implantation
After implantation, the device is programmed and gradually adjusted to the patient’s needs. Patients typically have three to five appointments during the first three months to optimize the settings.
Patients may notice improvement as the therapy is adjusted, although it can take three to six months to experience the full benefits. Afterward, the device is generally evaluated twice a year.
Barostim complements existing heart failure care rather than replacing it. Patients should continue taking prescribed medications and following their care team's recommendations.
If heart failure symptoms interfere with daily life, talk with your cardiologist or heart failure specialist. An evaluation can help determine whether Barostim may be appropriate for you.
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