Could Pacemakers Help Control Blood Pressure? AVIM therapy: A New Horizon in Blood Pressure Control
Could Pacemakers Help Control Blood Pressure? AVIM therapy: A New Horizon in Blood Pressure Control
1. AVIM Therapy – A Novel Approach:
Atrioventricular Interval Modulation (AVIM) is a pacing-based therapy delivered via dual-chamber pacemakers. It targets blood pressure reduction by modulating cardiac conduction intervals — without relying on medications.
2. Clinical Need:
Designed for patients with uncontrolled hypertension, particularly those who:
– Fail medication
– Struggle with adherence
– Experience drug intolerance
3. FDA Breakthrough Status (April 2025):
The BackBeat device by Orchestra BioMed, developed in partnership with Medtronic, received breakthrough designation. It’s being studied in patients with hypertension and preserved LVEF.
4. Evidence – MODERATO II Trial:
– 11.1 mm Hg reduction in 24-hour systolic BP at 6 months
– 8.1 mm Hg more than medication-only group (P < .001)
– Older adults with isolated systolic hypertension showed the most promise
5. Advantages:
– No dependence on patient adherence
– Minimal added risk for those already needing pacemakers
– Could reduce long-term cardiovascular events
6. Limitations & Caution:
– Not yet approved for patients without pacing indications
– Device implantation carries infection and procedural risks
7. Ongoing Trials:
– The BACKBEAT study (randomised, double-blinded) is enrolling 500+ patients
Bottom Line:
AVIM therapy may offer a promising nonpharmacologic solution for treatment-resistant hypertension — especially for older, complex patients — but widespread use depends on further evidence and ethical oversight.
