Members of MyAmyloidosisTeam are always looking for new and better ways to manage their health. One member with cardiac amyloidosis asked the question, “Does the Barostim device help wild-type amyloidosis?” Wild-type amyloidosis is a type of amyloidosis where a normal protein in the body, called transthyretin, becomes unstable and forms clumps. These deposits can build up in the body and cause problems, especially in the heart. In some cases, doctors use advanced tools like the Barostim device to help manage symptoms of serious heart failure.

Symptoms of cardiac amyloidosis can be difficult to manage. In this article, we’ll cover what the Barostim device is and how it’s used to help people with heart failure feel better. We’ll also discuss whether this device may help manage amyloidosis-associated heart failure. To learn more about the Barostim device, talk to a cardiologist who specializes in amyloidosis.

What Are Baroreceptors? How Do They Manage Blood Pressure?

To understand how the Barostim device works, it’s important to first learn about the role of baroreceptors in your body. Baroreceptors are sensory structures that monitor your blood pressure levels. They’re found in the walls of your heart, arteries, and veins. These sensors respond to changes in blood volume (the amount of blood in your body) and blood pressure.

For example, if your blood volume increases, the blood vessel walls are stretched out. The baroreceptors can sense this change to make sure your blood pressure levels remain normal. The baroreceptor reflex kicks in when your blood pressure changes as you move your body. When you go from lying down to standing up, the pressure on your blood vessel walls drops. The baroreceptors notice the change in blood pressure and send signals to raise the pressure while you stand.

To picture how this works, you can think of baroreceptors as pressure sensors inside a garden hose. When you stand up and your blood pressure drops, it’s like the hose suddenly feels less full. The baroreceptors sense this change and tell your body to raise the pressure so you don’t get dizzy.

The baroreceptors in your heart also respond to pressure changes. Your heart can beat faster and pump harder to compensate for a drop in blood pressure. All of these events together ensure your organs get the blood supply they need. People with a poor baroreceptor reflex may have unstable blood pressure levels and an abnormally fast heart rate.

How Does the Barostim Device Work?

The Barostim device is a small implantable device that’s placed just below your collarbone. It has an electrical connector that’s placed on the carotid artery in your neck. These large blood vessels bring oxygen-rich blood to your neck, face, and brain. The Barostim device delivers small electrical pulses to the baroreceptors in the carotid artery. These pulses trigger the baroreceptors to communicate with the brain. The brain then sends other signals out to tell the heart and blood vessels to relax. This ultimately lowers blood pressure and reduces strain on the heart.

Pulses from the Barostim device also result in the body making fewer stress-related hormones, which further reduces the symptoms of heart failure. The kidneys receive signals to reduce blood volume. The less blood volume you have, the lower your blood pressure will be, and the better you should feel.

Side Effects of the Barostim Device

Large studies called clinical trials looked at the potential side effects of the Barostim device. They can include:

• Low blood pressure that may raise your risk of dizziness and falls from fainting
• Allergic reactions to the device
• Infections
• The risks associated with the surgical procedure to implant the device
• Nerve or artery damage
• Worsening of your heart failure symptoms
• A blood clot in the brain that blocks blood flow, leading to stroke
• Death (only in severe cases)

Who’s a Candidate for the Barostim Device?

The U.S. Food and Drug Administration (FDA) approved the Barostim Neo System in 2019. It’s specifically approved for people with advanced heart failure who can’t have other treatments. For instance, if someone isn’t a candidate for cardiac resynchronization therapy (CRT, often referred to as a pacemaker), they may be eligible for a Barostim device.

In a person with heart failure, the heart muscle can’t pump hard enough to send blood throughout the body. This may be because the muscle is too stiff or weak to fill with blood and squeeze. Long-term high blood pressure puts extra strain on the heart. As time goes on, the heart becomes weaker from trying to pump against too much pressure.

The FDA notes that candidates for the Barostim device need to have a regular heart rhythm and a left ventricular ejection fraction (LVEF) less than or equal to 35 percent. LVEF measures how much blood leaves the heart with each beat. A normal LVEF measurement is 55 percent to 75 percent.

How Effective Is the Barostim Device?

The Barostim device is not a cure but a cardiac symptom management tool. It may help treat people with heart failure who aren’t sick enough to need more intensive treatments. Studies show that those with less severe heart failure need other treatment options to improve their quality of life.

One report looked at 554 people with heart failure who received a Barostim device. Although this study didn’t include people with cardiac amyloidosis, the results still help us understand how well the device works. The researchers found that the Barostim device made a significant difference in the participants’ quality of life. It helped them be more active and eased their heart failure symptoms. The study authors also looked at certain substances in the blood, called biomarkers, which can show how serious heart failure is. People who used the Barostim device had lower levels of these substances, which is a good sign.

The study didn’t specify whether any participants had heart failure caused by cardiac amyloidosis.

Can a Barostim Device Treat Heart Failure From Amyloidosis?

People diagnosed with cardiac amyloidosis eventually develop heart failure. Abnormal amyloid proteins clump together and collect in the heart muscle. As the proteins build up, the heart has a harder time pumping blood efficiently. The extra strain leads to muscle weakness and failure.

In theory, the Barostim device could help treat heart failure symptoms from cardiac amyloidosis. However, there currently aren’t any studies looking at the device for this specific heart disease. More research is needed to understand whether this device could help people with amyloidosis-associated heart failure.

As mentioned, candidates for the Barostim device need to have a normal heart rhythm. Many people living with cardiac amyloidosis have arrhythmia, or abnormal heart rhythm, because of problems with their heart’s electrical circuit. One common problem in cardiac amyloidosis is atrial fibrillation (AFib), which is a type of arrhythmia. Unfortunately, having AFib with cardiac amyloidosis would disqualify you from treatment with the Barostim device.

Other Ways To Treat Amyloidosis-Associated Heart Failure

Even if you aren’t a candidate for the Barostim device, there are other ways to manage heart failure. The most important goal is to treat your underlying cardiac amyloidosis. This helps prevent more amyloid proteins from collecting in and damaging your heart tissue.

Your doctor may also recommend:

• Diuretics (water pills) to get rid of extra fluid in the body to lower your blood volume and pressure
• Anti-arrhythmia medications to restore normal heart rhythm
• Blood thinners to lower the risk of blood clots
• Implantable cardioverter defibrillators (ICDs) or pacemakers to control your heart rhythm

If your cardiac amyloidosis is severe, you may need to be placed on the waiting list for a heart transplant. Before moving forward with the transplant, doctors will need to treat the underlying cause of your amyloidosis.

Talk With Others Who Understand

On MyAmyloidosisTeam, the social network for those living with amyloidosis, members come together to discuss life with amyloidosis and share their experiences.

Have you discussed the Barostim device with your cardiologist? What other treatments for cardiac amyloidosis have you used since being diagnosed? Share your experience in the comments below, or start a new conversation on your Activities page.