Cardiorenal axis and arrhythmias: Will renal sympathetic denervation provide additive value to the therapeutic arsenal?

Impact of Renal Denervation on Atrial Arrhythmogenic Substrate in Ischemic Model of Heart Failure

“…We did not investigate the regulation of the renin–angiotensin–aldosterone system comprehensively in the present study. Finally, RDN has been demonstrated to attenuate sympathetic outflow via the central nervous system to the heart and other organs 9. It has been reported that noninvasive methods of central sympathetic inhibition, such as clonidine, might have a cardioprotective effect 39.…”

“…Finally, RDN has been demonstrated to attenuate sympathetic outflow via the central nervous system to the heart and other organs. 9 It has been reported that noninvasive methods of central sympathetic inhibition, such as clonidine, might have a cardioprotective effect. 39 Therefore, this noninvasive method may yield results similar to RDN.…”

“…Renal denervation (RDN) has been demonstrated to attenuate sympathetic outflow via the brain to the heart as well as decreasing systemic catecholamine excretion 9. Although the Symplicity HTN‐3 trial failed to demonstrate a beneficial result of RDN in patients with resistant hypertension,10 several studies showed that RDN might have great potential in the treatment of cardiovascular diseases including HF11 and AF,12 beyond the changes of blood pressure.…”

“…well as decreasing systemic catecholamine excretion. 9 Although the Symplicity HTN-3 trial failed to demonstrate a beneficial result of RDN in patients with resistant hypertension, 10 several studies showed that RDN might have great potential in the treatment of cardiovascular diseases including HF 11 and AF, 12 beyond the changes of blood pressure. We recently reported that atrial arrhythmogenesis was regulated by RDN, mostly through suppressing structural remodeling in rapid ventricular 4-week pacing models.…”

Raising the Bar in Renal Sympathetic Denervation Research and Reporting

“…McArdle and colleagues recently observed that “Despite the recent failure of Symplicity HTN‐3 to reach its primary end point, burgeoning evidence in many alternative areas suggests the potential to overcome current therapeutic hurdles.” They also stated that preliminary data continue to support the use of RDN to regulate sympathetic nervous system–derived pathology, “with suggestions for benefit outside of strictly antihypertensive effects.” These include heart failure (vascular stiffness, systolic heart failure, heart failure with a preserved ejection fraction), arrhythmias (atrial fibrillation, ventricular tachyarrhythmias), chronic kidney disease, metabolic disease, insulin resistance, obstructive sleep apnea, myocardial ischemia, and stroke (see also). The authors also noted that, as for initial results in the field of RH, “lack of adequate sample size and controls limits interpretation and application of these results,” and that there are currently more than 100 registered randomized clinical trials designed to further inquire into such indications …”