Novant Health cardiothoracic surgeons are treating systolic heart failure patients with an advanced, minimally invasive therapy that’s not widely available in North Carolina.
Outpatient and inpatient Barostim procedures are performed at both Novant Health New Hanover Regional Medical Center and Novant Health Presbyterian Medical Center. New Hanover Regional has completed more than 19 implants since October 2024. Presbyterian Medical Center launched their program in September 2025. South Carolina’s program will start in 2026.The therapy targets the left ventricle’s inability to pump sufficient blood in advanced heart failure patients. Barostim works by electrically stimulating the carotid baroreceptors to increase baroreceptor signaling, rebalance the autonomic nervous system, and improve heart failure symptoms. Complementary to GDMT (guideline directed medical therapy), Barostim has shown significant improvements in exercise capacity, quality of life and NYHA class.
Though Barostim requires an implantable device, the procedure does not involve hardware in the heart or vessels, unlike defibrillators and pacemakers which treat arrhythmia. Instead, Barostim treats heart failure symptoms by sending electrical pulses to baroreceptors on the carotid artery of the neck. This rebalances the autonomic nervous system, which relaxes blood flow to the brain and increases heart, kidney, and circulatory function.
The U.S. Food and Drug Administration approved Barostim for heart failure patients in 2019, with clinical data from the BeAT-HF trial showing improvement in symptoms and overall quality of life.
A leader in advanced heart care treatment
Barostim specifically targets symptoms for patients who neither benefit from medication nor require a transplant or pump, said cardiothoracic surgeon Dr. Jeko Madjarov of Novant Health Heart & Vascular Institute.
“A major advantage of the Barostim technology is its capacity to help patients who continue to struggle with the symptoms of heart failure despite guideline directed medical therapy or those who have failed other device therapies such as cardiac resynchronization therapy (CRT)” Madjarov said. “Barostim complements rather than competes with currently available therapies, and it’s a safe procedure that can improve the patient’s quality of life.”
Madjarov was the first Novant Health cardiothoracic surgeon to perform the advanced heart therapy and is among the few trained physicians in the state offering it.
Indications:
- On GDMT that remain symptomatic
- LVEF < 35%
- NYHA Class III or Class II with recent Class III
- NT-proBNP < 1,600 pg/mL
How Barostim works
Barostim works by electrically stimulating the carotid baroreceptors to increase baroreceptor signaling, rebalance the autonomic nervous system, and improve heart failure symptoms. Complementary to GDMT (guideline directed medical therapy), Barostim has shown significant improvements in exercise capacity, quality of life and NYHA class.
Once the Barostim device is implanted under the skin, a catheter electrode is tunneled to the carotid artery to stimulate baroreceptors and regulate blood flow.
“By doing this we are able to recalibrate the autonomic nervous system, which makes it easier for the heart to work and ultimately makes the patient feel better,” Madjarov said.
The outpatient surgery takes about one hour and requires two small incisions in the neck and chest to accommodate the device battery and wire. Most patients tolerate the procedure under general anesthesia and are able to return home that day and resume normal activity that same week.
Recovery and improvement over time
Within three months, the Barostim procedure can improve exercise capacity, functional capacity and quality of life, Madjarov said.
Novant Health Heart & Vascular Institute follows up with the patient every six months following post-implant therapy optimization through titration visits to ensure that the device is maintaining the electrical signal and preserving battery life. The battery is designed to last at least five years and can be replaced with a simple procedure.
Heart failure specialists and general cardiologists identify Barostim candidates in clinic
General Cardiology Clinics:
- Hospitalized for heart failure
- Remain Class II or III despite max tolerated GDMT
- Limited impaired functional capacity
Device Clinics:
- Implantable cardioverter-defibrillator (ICD) who remain symptomatic and are not candidates for cardiac resynchronization therapy (CRT)
- Remain symptomatic with CRT
- Frequent heart failure device alerts
Heart Failure Clinics:
- Referred for transplant or LVAD with stage C
- PA pressure sensor patients with persistently high filling pressures
- Patients with a left ventricular ejection fraction of less than 35%
