A Case Report of Renal Sympathetic Denervation for the Treatment of Polymorphic Ventricular Premature Complexes

Abstract

Premature ventricular complexes are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, Armaganijan et al reported the relevance of sympathetic activation in patients with ventricular arrhythmias and suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden.In this report, we describe a 32-year-old hypertensive male patient presenting with a high incidence of polymorphic premature ventricular complexes on a 24 hour Holter monitor. Beginning 1 year prior, the patient experienced episodes of presyncope, syncope, and tachycardia palpitations. The patient was taking losartan 100 mg/day, which kept his blood pressure (BP) under control, and sotalol 160 mg twice daily. Bisoprolol 10 mg/day was used previously but was not successful for controlling the episodes. The 24 hour Holter performed after the onset of sotalol 160 mg twice daily showed a heart rate ranging between 48 (minimum)–78 (average)–119 (maximum) bpm; 14,286 polymorphic premature ventricular complexes; 3 episodes of nonsustained ventricular tachycardia, the largest composed of 4 beats at a rate of 197 bpm; and 14 isolated atrial ectopic beats. Cardiac magnetic resonance imaging with gadolinium perfusion performed at rest and under pharmacological stress with dipyridamole showed increased left atrial internal volume, preserved systolic global biventricular function, and an absence of infarcted or ischemic areas. The patient underwent bilateral renal sympathetic denervation.The only drug used postprocedure was losartan 25 mg/day. Three months after the patient underwent renal sympathetic denervation, the mean BP value dropped to 132/86 mmHg, the mean systolic/diastolic 24 hour ambulatory BP measurement was reduced to 128/83 mmHg, and the 24 hour Holter monitor showed a heart rate ranging between 51 (minimum)–67 (average)–108 (maximum) bpm, 854 polymorphic premature ventricular complexes, and no episodes of nonsustained ventricular tachycardia.

Effect of Renal Denervation on Suppression of PVC and QT Prolongation in a Porcine Model of Acute Myocardial Infarction

“…Relative excess of sympathetic compared to vagal activity may be an important factor in genesis of VA during AMI 13). RDN was known to reduce renal sympathetic activity as assessed by NE spillover, modulate the sympathetic nervous system and to reduce recurrent VA 3)4)5)6)7)8)14). RDN has been shown to suppress spontaneous PVC and reduced the incidence of VF in pig model.…”

“…Recently the beneficial effect of renal denervation (RDN) has been documented in patients suffering from hypertension 2). These effect in hypertensives showed that RDN could modulate the sympathetic nervous system and ventricular electrophysiology 3)4)5)6)7)8). However, antiarrhythmic effect of catheter based RDN after AMI in the early period remains unclear.…”

The impact of renal sympathetic denervation on cardiac electrophysiology and arrhythmias: A systematic review of the literature

“…In an interesting case report, a 32-year-old hypertensive male with a high burden of PVCs, non-sustained VT, and atrial ectopic beats on 24h Holter monitoring underwent RDN [40]. After the onset of sotalol the number of PVCs, non-sustained VT and atrial ectopic beats was reduced while three months after the procedure, the 24h holter monitoring showed further reduction of PVCs while no episodes of nonsustained VT were recorded [40].…”

“…After the onset of sotalol the number of PVCs, non-sustained VT and atrial ectopic beats was reduced while three months after the procedure, the 24h holter monitoring showed further reduction of PVCs while no episodes of nonsustained VT were recorded [40].…”

Renal denervation for the treatment of ventricular arrhythmias: A systematic review and meta‐analysis

“…Six studies reported the effects of RDN on PVCs. Three of them evaluated patients with resistant hypertension, [22][23][24] two assessed patients with no significant comorbidities, except for the high incidence of PVCs, 25,26 and one was a report case of a patient with congenital long QT syndrome. 27 The details of the studies are summarized in the Table S3.…”