What are the primary recommendations for caring for a patient with a Barostim (Baroreflex Activation Therapy) device?

Primary Recommendations for Barostim (Baroreflex Activation Therapy) Device Care

Barostim device care requires regular follow-up, proper electromagnetic interference management, and continuous monitoring of device function to ensure optimal patient outcomes and reduce complications.

Device Follow-Up and Monitoring

• Six-month intervals for device follow-up are generally safe, but more frequent evaluations may be required depending on device characteristics and the patient's clinical status 1
• Device interrogation should be performed at each follow-up visit to assess battery status, lead system parameters, and elective replacement indicators 1
• Remote monitoring techniques can supplement but cannot entirely replace in-person clinic visits 1
• Continuous cardiac monitoring is essential in the immediate post-operative period to ensure proper device function 1

Electromagnetic Interference (EMI) Management

• For surgical procedures involving electrocautery:

  • Position the electrosurgical receiving plate so the current pathway does not pass through or near the device 1
  • Use short, intermittent bursts at the lowest feasible energy levels 1
  • Consider using bipolar electrocautery or ultrasonic (harmonic) scalpel instead of monopolar systems when possible 1
  • Continuously monitor cardiac rate and rhythm during procedures 1

• For MRI procedures:

  • Consult with the ordering physician, cardiologist, radiologist, and device manufacturer before proceeding 1
  • Surgical relocation of the device may be necessary if it will be in the field of radiation 1

Device Programming and Function

• Device programming is typically initiated at implantation and should be reviewed periodically 1
• Particular attention should be given to review of sensing parameters, programmed therapies, device activation, and event logs 1
• When device function is modified, testing may be warranted to evaluate sensing and pacing functions 1

Patient Education and Lifestyle Considerations

• Patients should carry proper identification and information about their device at all times 1
• Discuss limitations on specific physical activities, driving restrictions, and potential electromagnetic interference sources 1
• Patients should avoid driving for at least 7 days after implantation to allow for proper healing 2
• Monitor for device-related anxiety, which is common and can affect quality of life 1

Complication Management

• Common side effects of Barostim therapy include local discomfort, which occurs in nearly all patients (97.6%), primarily within the first 6 months after device activation 3
• Most mild adverse events can be resolved by optimization of device parameters 3
• Regular patient visits are necessary to register side effects and adjust parameters accordingly 3
• Monitor for moderate adverse events such as hypertensive crisis, syncope, or arrhythmias, which occur in approximately 28.6% of patients 3

Clinical Benefits Monitoring

• Barostim therapy has been shown to significantly improve exercise capacity, quality of life, and NYHA functional class in heart failure patients 4, 5
• In hypertensive patients, monitor for blood pressure reduction, which is a primary therapeutic effect 3, 6
• Assess for reduction in NT-proBNP levels in heart failure patients, which can indicate improved cardiac function 4, 5

Emergency Management

• In case of device malfunction, immediately contact the primary device management team 1
• For non-life-threatening situations, defer device management to patients and their family caregivers until contact can be established with the device center or manufacturer technical support 1
• Ensure backup equipment is available and transported with the patient during emergencies 1

By following these recommendations, healthcare providers can ensure optimal function of Barostim devices while minimizing complications and maximizing therapeutic benefits for patients.