FDA’s Green Light For Heart Failure Study Using CardioFit® Vagus Nerve Stimulation System

“We’ve long known that an early marker of HF is an imbalance in the autonomic nervous system and that this imbalance contributes to HF morbidity and mortality, but we’ve only been able to treat one side of the problem using prescription medications. If the study of the CardioFit proves successful, this may be key to understanding how to treat and prevent the progression of HF.”

In short

Israeli company BioControl Medical has announced U.S. FDA approval to begin the second phase of INOVATE-HF (INcrease Of VAgal TonE in Heart Failure), a global, multi-centre, investigational device exemption (IDE) clinical study of the company’s CardioFit® system for heart failure. The approval, which is based on the successful completion of an initial phase involving 50 patients at 21 centers worldwide, allows unconditional study expansion of up to 200 patients at 50 U.S. centres.

Background

One of the hallmarks of heart failure (HF) is an imbalance in the autonomic nervous system, which regulates involuntary bodily functions including heart muscle activity. In healthy individuals, the two branches of the autonomic nervous system, called the sympathetic and the parasympathetic, work in concert to regulate the heart. At the most basic level, the sympathetic increases cardiovascular activity, while the parasympathetic decreases it. In people with HF, the balance between these two branches is disrupted, leading to added stress on the heart and progressive deterioration of cardiovascular function.

While prescription medications have been successful at treating the sympathetic branch to reduce select symptoms, there have been no treatments designed to specifically and safely target the parasympathetic branch. BioControl developed CardioFit in order to activate the parasympathetic nervous system directly to reduce stress on the heart, thereby alleviating HF symptoms and reversing HF deterioration. It operates by stimulating the vagus nerve on the right side of the neck.

The CardioFit system consists of a stimulator, a sensor lead and a stimulation lead, which are implanted under the skin of the chest. The sensor lead is extended from the stimulator to the right ventricle of the heart, and the stimulation lead is extended from the stimulator to the vagus nerve on the right side of the neck. Once activated, the stimulator’s electrical pulses are transferred via the stimulation lead to the vagus nerve. At the same time, the sensor lead monitors changes in heart activity and turns stimulation on or off accordingly. Like a pacemaker, the CardioFit System can be programmed on and off via external wireless communication with the device.

The study

Initiated in April 2011, INOVATE-HF is a prospective, randomised, controlled clinical study to determine the safety and efficacy of the CardioFit implantable electrical stimulation device. The study will evaluate the system’s potential to reduce hospitalisation and death among patients with HF, while also exploring whether combined treatment with CardioFit and prescription drug therapy is more effective than drug therapy alone.1

INOVATE-HF will ultimately enroll up to 650 patients at up to 80 centers in the United States and Europe. Results of the INOVATE-HF study will be used to support a Premarket Approval Application (PMA) to the U.S. Food and Drug Administration (FDA) for market clearance of CardioFit.

Company comments

“The FDA’s approval to expand INOVATE-HF is a wonderful validation of the excellent clinical work completed in phase one of the study,” said Ehud Cohen, Ph.D., chief executive officer of BioControl Medical. “We applaud the efforts of our trial investigators and coordinators, who are fundamental to driving this pioneering research, and we look forward to working with a broader group of sites across the United States in the near future.”

Clinician comments

“INOVATE-HF is an important study that may lead to an entirely new approach for treating congestive heart failure,” said Dr. Gregory Ewald, INOVATE-HF principal investigator at Washington University School of Medicine. “We’ve long known that an early marker of HF is an imbalance in the autonomic nervous system and that this imbalance contributes to HF morbidity and mortality, but we’ve only been able to treat one side of the problem using prescription medications. If the study of the CardioFit proves successful, this may be key to understanding how to treat and prevent the progression of HF.”

Regulatory status 

In the United States, the CardioFit is an investigational device. Limited by Federal (or United States) law to investigational use. The system gained CE mark clearance in January 2009.

References

1 Hauptman PJ, Schwartz PJ, Gold MR, Borggrefe M, Van Veldhuisen DJ, Starling, RC, Mann DL. “Rationale and study design of the INcrease Of Vagal TonE in Heart Failure study: INOVATE-HF.” American Heart Journal (June 2012) 163 (6): 955-962.

2 De Ferrari GM, Crijns HJ, Borggrefe M, Milasinovic G, Smid J, Zabel M, Gavazzi A, Sanzo A, Dennert R, Kuschyk J, Raspopovic S, Klein H, Swedberg K, Schwartz PJ. “Chronic vagus nerve stimulation: a new and promising therapeutic approach for chronic heart failure.” Eur Heart J (2011) 32 (7): 847-855.

Source: BioControl Medical, Business Wire