BackgroundAtrial fibrillation (AF) commonly occurs in association with chronic kidney disease (CKD), resulting in adverse outcomes. Combining pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may reduce the recurrence of AF in patients with CKD and hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. Our goal was to compare the impact of PVI + RSD with that of PVI alone in patients with concurrent AF and CKD.MethodsThis was a single-center, prospective, longitudinal, randomized, double-blind study. Forty-five patients with controlled hypertension, symptomatic paroxysmal AF and/or persistent AF, stage 2 or 3 CKD, and a dual-chamber pacemaker were enrolled from January 2014 to January 2015. We assessed the 30-second recurrence of AF recorded by the pacemaker, 24-hour ambulatory blood pressure measurements, estimated glomerular filtration rate, albuminuria, echocardiographic parameters, and safety of RSD.ResultsNo patient developed procedural or other complications. The ambulatory blood pressure measurements did not differ within the PVI + RSD group or between the PVI + RSD and PVI groups throughout the study. Significantly more patients in the PVI + RSD group than in the PVI group were free of AF at the 12-month follow-up evaluation. The PVI group had an unacceptable response to ablation with respect to changes in echocardiographic parameters, whereas these parameters improved in the PVI + RSD group.ConclusionPVI + RSD were associated with a lower AF recurrence rate than PVI alone; it also improved renal function and some echocardiographic parameters. These encouraging data will serve as baseline information for further long-term studies on larger patient populations.
In past decades, multiple organ dysfunctions 1 provoked by cardiopulmonary bypass (CPB) have been studied. The short-and long-term results and higher cost of CPB changed the scientific focus, causing less harm to the patient and giving more emphasis to off-pump and minimally invasive surgery. Many articles appeared. Benetti 2 and Karagoz and associates 3 contributed to the progress of minimally invasive direct coronary artery bypass (MIDCAB).With further investigation, we believe in the possibility of performing a MIDCAB in the ambulatory patient. We therefore operated on a series of selected patients who were totally awake and without orotracheal intubation. They were discharged from the hospital within 24 hours after the operation.
MethodsBetween January 2000 and May 2001, 20 patients were subjected to coronary artery bypass while fully awake, without the use of CPB or an orotracheal tube. All patients had a lesion in the left anterior descending artery, and none had important chronic pulmonary disease. Ages varied between 41 and 75 years, and the predominant sex was male. All patients were subjected to preoperative psychologic preparation.From the Departments of Cardiothoracic Surgery, a Anesthesiology, b and Cardiology, c the Hospital Sa ˜o Jose ´do Avaı ´, Itaperuna/RJ, Brazil.
<p><strong>Aim: </strong>The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).</p><p><strong>Methods and results</strong>: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 <em>vs.</em> 116±8/79±3 and 115±8/79±4 mmHg, respectively). No change was also observed in the RSD group (117±8/81±2 <em>vs.</em> 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.</p><p><strong>Conclusions:</strong> For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.</p>
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