Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension

Donazzan, Luca; Mahfoud, Felix; Ewen, Sebastian; Ukena, Christian; Cremers, Bodo; Kirsch, Carl-Martin; Hellwig, Dirk; Eweiwi, Tareq; Ezziddin, Samer; Esler, Murray; Böhm, Michael

doi:10.1007/s00392-015-0930-4

Cited by 55 publications

(29 citation statements)

References 39 publications

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“…Also, a number of single center, non randomized trials suggested favorable effects of RDN on a series of subclinical states (like left ventricular hypertrophy regression, improvement of arterial stiffness and reduction of arrhythmic burden etc) beyond BP reduction [4][5][6]. From a pathophysiological point of view, although the data are conflicting, it seems most possible that RDN significantly reduces the central sympathetic outflow leading to decreased cardiac sympathetic activity, an effect that may favorably affect atrial and ventricular arrhythmias [7]. The aim of this review was to systematically analyze studies that investigate the impact of RDN on cardiac conduction system as well as its effect on atrial and ventricular arrhythmias.…”

Section: Introductionmentioning

confidence: 93%

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

Bazoukis

Korantzopoulos

Tsioufis

2016

International Journal of Cardiology

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Section: Introductionmentioning

confidence: 93%

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

Bazoukis

Korantzopoulos

Tsioufis

2016

International Journal of Cardiology

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“…Однако кроме оценки эффективности этих мето-дов остаются неясными разные аспекты лечения: предикторы успеха и критерии эффективности про-цедур, длительность эффекта, возможность повреж-дения эндотелия сосудов, риск развития нежелатель-ных эффектов [22][23][24][25][26][27][28][29].…”

Section: фармакотерапия рагunclassified

Problem of resistant arterial hypertension in the family doctor practice

Korzh¹

2015

Shidnoevr. z. vnutr. simejnoi med.

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“…Cardiac 123 I-mIBG uptake is thought to reflect the density of sympathetic innervation. 17 The timing of mIBG uptake is tissue-specific. 15 Most cardiac 123 I-mIBG studies image early and late uptake at approximately 15 min and 3-4 h after injection, respectively, whereas oncologic studies typically image at roughly 24 h. 18 Washout rate is determined as the rate of decrease in myocardial uptake between early and delayed imaging and reflects sympathetic activity and tone.…”

mentioning

confidence: 99%

“…In the heart, a high washout rate indicates increased sympathetic activity, 16 and unlike uptake, is independent of the number of neurons in the tissue. 17 In heart failure, variations in cardiac 123 I-mIBG uptake and washout correlate with the risk of future adverse cardiac events 19 and therapeutic interventions in heart failure patients have been shown to lead to increases in uptake. [20][21][22] These findings suggest that 123 I-mIBG scintigraphy can reflect dynamic changes in adrenergic function in the heart.…”

mentioning

confidence: 99%

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123I-mIBG scintigraphy: Clinical tool for assessing renal sympathetic activity?

George

Bhambhvani

Oparil

2017

Journal of Nuclear Cardiology

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See related article, pp. 363-371Among patients with treatment-resistant hypertension, transcatheter renal denervation has been shown to reduce blood pressure (BP) in a number of uncontrolled, unblinded clinical trials.1 However, in a prospective, single-blind, randomized trial that compared transcatheter renal denervation to a sham procedure, there was no significant difference in systolic BP between the two treatment arms at 6 months follow-up.2 Proposed reasons for the lack of benefit include a substantial placebo effect related to the procedure, differences in medication adherence such that the sham-treated control group may have taken more antihypertensive medications, operator inexperience with transcatheter renal denervation, and performance of an inadequate number of ablations in each renal artery.3 It has been postulated that operator inexperience and performance of too few ablations may have led to incomplete denervation and therefore an inadequate BP response to the procedure. The absence of a readily available methodology to define completeness of transcatheter renal denervation in humans remains as an unmet need in defining the potential role of the procedure in clinical practice.The contribution of increased renal sympathetic tone to the pathophysiology of hypertension has been known for decades. Surgical renal denervation in hypertensive animal models has been shown to cause significant decreases in BP compared to sham controls. 4 A commonly employed method of surgical denervation involves stripping the adventitia from the renal artery of hypertensive rats and exposing the artery to phenol, a compound that irreversibly blocks neural conduction. 5Renal norepinephrine (NE) content measured at specified time points after surgical denervation in hypertensive rats has been shown to decrease dramatically (94% reduction compared to sham-controlled rats at 1 week; P \ 0.001), suggesting complete ablation of the renal nerves. A positive correlation was also shown between absolute change in BP after denervation and renal NE content in denervated animals (r = 0.80, P \ 0.001). 4In the clinical research setting, a number of methods have been utilized to assess the completeness of renal denervation in hypertensive humans. The most promising and best characterized are the measurements of muscle sympathetic nerve activity (MSNA), renal NE spillover rate, and assessment of sympathetically mediated responses to electrical stimulation of the renal artery before and after denervation.6-8 Assessment of MSNA is minimally invasive and entails percutaneous insertion of a recording electrode into a superficial nerve (peroneal or radial), allowing direct recording of postganglionic sympathetic neural bursts. MSNA reflects moment-to-moment sympathetic outflow from the central nervous system to either skeletal muscle or skin, but does not provide direct information on sympathetic outflow to the kidney or heart. 9Renal NE spillover is assessed by infusing small doses of radiolabeled NE intravenously and measuring its level in...

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Effects of catheter-based renal denervation on cardiac sympathetic activity and innervation in patients with resistant hypertension

Abstract: RDN significantly reduced cardiac sympathetic activity thereby demonstrating a direct effect on the heart. These changes occurred independently from BP effects and provide a pathophysiological basis for studies, investigating the potential effect of RDN on arrhythmias and heart failure.

Cited by 55 publications

References 39 publications

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

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

Problem of resistant arterial hypertension in the family doctor practice

123I-mIBG scintigraphy: Clinical tool for assessing renal sympathetic activity?

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