Device Offers Hope For Systolic Failure

Barostim Baroreflex therapy uses neuromodulation to ‘change’ patient’s life.

When the snow finally melts and the temperature rises above 70 degrees, residents of northwestern New York head for the beach in droves. Gary Brown knows this because he made his living selling sunscreen in an area better known for snow days than beach days.

Gary Brown

Gary Brown

“We sold a lot of product up there, most of it through two grocery store chains, Wegmans, which is in the Rochester area, and Fay’s Drug Store, which has about 270 stores in and around Syracuse,” Gary says.

Following a job transfer in 1998, Gary finished his 35-year career selling Coppertone products in Florida, where he eventually eased into retirement. Heart issues have made retirement far more stressful than Gary, 74, expected.

“It’s a problem I inherited,” Gary explains. “My mother had congestive heart failure, and I first started to experience issues myself in 2006. I was experiencing a lot of dizziness and shortness of breath.”

Gary’s dizziness and breathing difficulties were eventually linked to atrial fibrillation, or AFib, a common condition in which a lack of coordination between the heart’s upper and lower chambers leads to an irregular or rapid heartbeat.

Gary’s condition was initially treated through radiofrequency ablation, a procedure that uses radiofrequency energy, or heat, to restore the heart’s normal rhythm. When that procedure failed to provide the desire result, Gary was fit with a pacemaker.

That was in 2019. Since then, Gary suffered a stroke that greatly weakened his left arm and leg. After a move from Clearwater to Bradenton, he recently came under the care of Jared A. Collins, DO, at the Bradenton Cardiology Center.

Shortly after, Gary began to struggle with fatigue so great he could no longer walk even short distances or perform basic household chores without becoming exhausted.

“My mailbox is about 75 feet from my house,” Gary relates. “I was getting so fatigued that if I went out to get the mail, I needed to use a walker to get there and back; and after I came back, I was so tired that I had to lie down and take a nap afterward.”

Concerned with his health, Gary brought the issue up to Dr. Collins, who discovered that Gary was suffering from systolic heart failure, a condition where the heart fails to pump enough blood to the rest of the body during each contraction.

“His rhythm was normal, but his ejection fraction, which is a measure of how severe heart failure can be in certain patients, was seriously dysfunctional,” Dr. Collins reports. “It was less than 20 percent, and a normal ejection fraction is between 55 and 65 percent.”

Systolic heart failure is usually treated with medications designed to make the heart pump blood more efficiently, but Gary didn’t react well to the drugs Dr. Collins prescribed.

“We tried treating Gary with medications for several months,” Dr. Collins confirms. “Unfortunately, his blood pressure dropped significantly because of those medications, so it became apparent to us that he would not be able to tolerate even mild doses.

“The good news, though, is that patients such as Gary who can’t take the medications, have an ejection fraction of less than or equal to 35 percent, and are not candidates for cardiac resynchronization are candidates to receive a new advanced treatment.”

Among the First 

Available at Manatee Memorial Hospital, this leading-edge treatment option is called Barostim™ Baroreflex Activation Therapy. Manatee Memorial was one of the first hospitals in the region as well as one of the first in the Universal Health Services realm to make it available.

The first of its kind to be approved by the FDA, the Barostim therapy system uses neuromodulation – the power of the brain and nervous system – to activate a group of cells in the neck called baroreceptors that sense how blood flows through the carotid arteries.

The system is implanted beneath the right collar bone. It contains a pulse generator and a single lead that attaches to the carotid artery. The lead delivers the electrical impulses to the baroreceptors, which also relay information regarding blood flow to the brain.

Once the brain receives the information concerning blood flow, it sends a return signal to the heart and blood vessels that relaxes the vessels and alters the production of certain stress-related hormones that cause heart failure symptoms.

Since receiving the Barostim device last June, Gary has responded “phenomenally” and his activity level “has taken off.”

Since receiving the Barostim device last June, Gary has responded “phenomenally” and his activity level “has taken off.”

Through proper function, the heart eventually regains strength, which reduces the symptoms associated with heart failure and allows the patient to return to normal activities while also lessening the risks of other heart failure-related issues such as kidney disease.

Defined by Dr. Collins as “novel technology” because it does not touch the heart, the Barostim system is about the size of a pacemaker and can be implanted on an outpatient basis in about an hour while the patient is under general anesthesia.

During the implantation of Gary’s Barostim device, Dr. Collins was aided by Howard F. Hermans, MD, FACS, who was responsible for physically placing the electrodes on the carotid artery.

“There’s a V-shaped spot, or crux, where the carotid artery divides into two arteries,” Dr. Hermans educates. “At that crux, there’s a little pressure sensor that the body has that regulates blood pressure and the sympathetic system. That’s where I place the electrode.

“We map it out during the procedure to see where we’ll get the best response, then the electrode is secured to that area. The electrode then gets connected to the small generator and battery that is implanted in the chest wall.

“The system is initially set at the very lowest setting when the patient leaves the hospital. During a follow-up appointment, the cardiologist can make any necessary adjustments to the generator.” 

On the Rise 

Gary was the first patient in the region implanted with the Barostim device last June. Since then, he has responded “phenomenally” and his activity level “has taken off,” according to Dr. Collins.

“The most recent echocardiogram we took of Gary was in January, and the test showed that his ejection fraction has improved from less than 20 percent to between 40 and 45 percent,” Dr. Collins says. “That’s why his activity level is on the rise.

“This was a patient who couldn’t make it across my office without the help of a walker because of limiting shortness of breath. Now, he’s walking every day without assistance, and the distances he walked in 30 minutes two months ago he’s now walking in 20 minutes. 

“He’s even performing strength and resistance training at home.”

The Barostim system has not only alleviated Gary’s fatigue, it has also helped normalize his blood pressure. As a result, Gary is being treated with optimal doses of three fundamental heart failure medications.

“This treatment was designed to help improve quality of life, functional capacity and activity level, but in Gary it is also improving his life expectancy,” Dr. Collins notes. “That is a benefit we’ve seen in response from other patients as well.”

Members of the Manatee Memorial Hospital cardiac team are, from left: Dede Seitz-Couch, RN; Kimberly Chase, RCIS; Dawn Selvey, RN; Amy Kimball, divisional director of Invasive Cardiology; Dr. Hermans, Dr. Collins, Lindsay Borchak, CVT; Bruce MacDougall, RN; Justin Smith, RT R(CT); Joseph Hwang, COO.

Members of the Manatee Memorial Hospital cardiac team are, from left: Dede Seitz-Couch, RN; Kimberly Chase, RCIS; Dawn Selvey, RN; Amy Kimball, divisional director of Invasive Cardiology; Dr. Hermans, Dr. Collins, Lindsay Borchak, CVT; Bruce MacDougall, RN; Justin Smith, RT R(CT); Joseph Hwang, COO.

 

Gary says that when he learned he would be the first in the region with the Barostim system, he became a bit nervous. He went ahead with the procedure, he says, because he trusts Dr. Collins.

“He told me this device would change my life,” Gary confirms. “He said, You won’t keep having to go to the hospital, and you’ll be able to walk and do other normal activities without getting fatigued, and he was right.

“Before, I had been forced to curtail a lot of activities. I couldn’t exercise or play golf. I couldn’t even go out to dinner and enjoy life. But now, just like Dr. Collins said, I’ve got my life back.

“I really can’t thank Dr. Collins and Dr. Hermans enough for the work they did in fitting me with this device. It has absolutely changed my life, just as Dr. Collins said it would, and I’m thankful we have a place like Manatee Memorial Hospital that allows them to do this kind of work.”

© FHCN article by Roy Cummings. Gary’s photos by Jordan Pysz. Cardiac team photo courtesy of Manatee Memorial Hospital. js
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    • Manatee Memorial Hospital

      When it comes to choosing a hospital, one thing is clear: quality counts. Manatee Memorial Hospital has a long tradition of providing medical care in a comfortable and convenient environment each year for thousands of patients... Read More

    • Jared A. Collins, DO

      Jared A. Collins, DO, is a cardiology specialist who subspecializes in cardiac electrophysiology, which is the treatment of heart rhythm disorders. He earned his medical degree from the Kansas City University College of Osteopathic Medicine. He... Read More

    • Howard F. Hermans, MD, FACS

      Howard F. Hermans, MD, FACS, is a board-certified general and vascular surgeon. He earned his bachelor’s degree from Vassar College in New York and medical degree from what is now the Rutgers School of Biomedical and Health Sciences in New Jer... Read More