Baroreflex Activation Therapy in a Patient With Transthyretin Amyloid Cardiomyopathy

BACKGROUND: Transthyretin amyloid cardiomyopathy (TTR-CM) is a form of nonischemic cardiomyopathy associated with progressive heart failure, persistent symptoms, and reduced quality of life despite advances in medical therapy. CASE SUMMARY: We present a man with TTR-CM and heart failure with reduced ejection fraction who remained severely symptomatic despite guideline-directed medical therapy, cardiac resynchronization therapy, and atrial fibrillation ablation. Baroreflex activation therapy (BAT) using the Barostim device was implanted as adjunctive therapy, resulting in marked symptomatic improvement and significant gains in quality-of-life metrics. DISCUSSION: BAT is an established therapy for selected patients with refractory heart failure. Its role in TTR-CM-related cardiomyopathy has not been well described and may offer symptomatic benefit when conventional therapies are insufficient. TAKE-HOME MESSAGE: BAT may be a useful adjunctive therapy to improve symptoms and quality of life in selected patients with TTR-CM and refractory heart failure.