Impact of renal sympathetic denervation on cardiac sympathetic nerve activity evaluated by cardiac MIBG imaging

Berūkštis, Andrius; Vajauskas, Donatas; Gargalskaitė, U.; Misonis, Nerijus; Burneikaitė, Greta; Zakarkaite, Diana; Miglinas, Marius; Laucevičius, Aleksandras

doi:10.4244/eijv11i9a215

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…Selective RDN significantly reduces cardiac sympathetic overdrive assessed by 123I-MIBG scintigraphy. 39,40 A catheter-based approach for RDN has been developed for human use. RDN can result in an up to 50% reduction of renal norepinephrine spillover measured with a radiochemical tracer methodology using 3H-norepinephrine in humans.…”

Section: Modulation Of Renal Sympathetic Innervation By Renal Denervationmentioning

confidence: 99%

Modulation of renal sympathetic innervation: recent insights beyond blood pressure control

et al. 2018

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Renal afferent and efferent sympathetic nerves are involved in the regulation of blood pressure and have a pathophysiological role in hypertension. Additionally, several conditions that frequently coexist with hypertension, such as heart failure, obstructive sleep apnea, atrial fibrillation, renal dysfunction, and metabolic syndrome, demonstrate enhanced sympathetic activity. Renal denervation (RDN) is an approach to reduce renal and whole body sympathetic activation. Experimental models indicate that RDN has the potential to lower blood pressure and prevent cardio-renal remodeling in chronic diseases associated with enhanced sympathetic activation. Studies have shown that RDN can reduce blood pressure in drug-naïve hypertensive patients and in hypertensive patients under drug treatment. Beyond its effects on blood pressure, sympathetic modulation by RDN has been shown to have profound effects on cardiac electrophysiology and cardiac arrhythmogenesis. RDN can display anti-arrhythmic effects in a variety of animal models for atrial fibrillation and ventricular arrhythmias. The first non-randomized studies demonstrate that RDN may promote the maintenance of sinus rhythm following catheter ablation in patients with atrial fibrillation. Registry data point towards a beneficial effect of RDN to prevent ventricular arrhythmias in patients with heart failure and electrical storm. Further large randomized placebo-controlled trials are needed to confirm the antihypertensive and anti-arrhythmic effects of RDN. Here, we will review the current literature on anti-arrhythmic effects of RDN with the focus on atrial fibrillation and ventricular arrhythmias. We will discuss new insights from preclinical and clinical mechanistic studies and possible clinical implications of RDN.

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Section: Modulation Of Renal Sympathetic Innervation By Renal Denervationmentioning

confidence: 99%

Modulation of renal sympathetic innervation: recent insights beyond blood pressure control

et al. 2018

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“…However, we observed improvements in all echocardiographic parameters evaluated 12months post RSD. Recently, Berukstis et al [1] reported that RSD offers an innovative and safe catheter-based approach for selective reduction of renal sympathetic drive, which may explain, in part, our results. Previously, we described improvements in these parameters in 45 patients at 6 months post RSD, but these patients had resistant hypertension, LV hypertrophy and CKD [27].…”

Section: Discussionmentioning

confidence: 60%

“…Adequate control of HF and its progression is sometimes a difficult goal to achieve in this patient population, and in most cases, is only resolved after heart transplantation, which in turn is not easily accessible. Recently, Berukstis et al [1] reported that renal sympathetic denervation (RSD) offers an innovative and safe catheterbased approach for selective reduction of the renal sympathetic drive. They demonstrated that selective denervation of sympathetic nerves in the renal arteries significantly reduced cardiac sympathetic overdrive, as assessed by 123I metaiodobenzylguanidine (MIBG) scintigraphy, thus positively affecting HF progression.…”

Section: Introductionmentioning

confidence: 99%

Renal Sympathetic Denervation in Mild to Moderate Chronic Kidney Disease Patients with Chronic Heart Failure Refractory to Cardiac Resynchronization Therapy: A Safety Evaluation Study

Silva¹,

Paz²,

Souto³

et al. 2016

J Clin Exp Cardiolog

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Background: Heart failure (HF) is a challenging disease to control. Chronic overactivation of the sympathetic nervous system occurs early in HF and chronic kidney disease (CKD). The aim of this study was to evaluate the safety and effects of renal sympathetic denervation (RSD) in reducing lesions on the heart and kidneys in patients with CKD and HF refractory to cardiac resynchronization therapy (CRT). Methods and results: Twenty-one patients were included and treated with a standard irrigated cardiac ablation catheter. RSD was performed by a unique operator. All the patients included in the study had HF in functional New York Health Association (NYHA) class III, were refractory to CRT, and had mild-to-moderate CKD. Data were obtained at baseline, and at 6 and 12 months of follow-up. RSD was safe and feasible to perform in this population. No changes in blood pressure were observed during this period. At baseline, patients walked 172.4 ± 26.4 m during a 6-minute walk test, increasing to 209.4 ± 29.1 m at 12 months post RSD (p<0.001). All echocardiographic parameters evaluated improved at 6 (p<0.001) and 12 months (p<0.001) after RSD. Estimated glomerular filtration rate improved from 67.4 ± 20.5 mL/min/1.73 m 2 at baseline to 87.8 ± 17.9 mL/min/1.73 m 2 at 12 months post procedure (p<0.001). At 12 months after RSD, 42% of patients were in functional NYHA class I, 50% were in functional class II, and 8% remained in functional NYHA class III. Conclusions: RSD seemed to be safe, feasible, and effective, resulting in an improvement in echocardiographic parameters, 6-minute walk test distance, renal function, and functional NYHA class in mild-to-moderate CKD patients with HF refractory to CRT.

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“…1 ). There are 14 observational studies 7 , 12 , 14 – 25 (including 11 uncontrolled studies and 3 controlled studies) and 2 RCTs 26 , 27 . The baseline characteristics of included subjects was shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Effects of Renal Denervation on Cardiac Structural and Functional Abnormalities in Patients with Resistant Hypertension or Diastolic Dysfunction

Wang¹,

Yang²,

Zhao³

et al. 2018

Sci Rep

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The aim of the present study is to systematically evaluate the impact of RDN on cardiac structure and function in patients with resistant hypertension (RH) or diastolic dysfunction. We retrieved Pubmed, Embase and Cocharane Library databases, from inception to April 1st, 2016. Studies reporting left ventricular mass (LVMI) or left ventricular (LV) diastolic function (reflected by the ratio of mitral inflow velocity to annular relaxation velocity [E/e’]) responses to RDN were included. Two randomized controlled trials (RCTs), 3 controlled studies and 11 uncontrolled studies were finally identified. In observational studies, there was a reduction in LVMI, E/e’ and N-terminal pro B-type natriuretic peptide (BNP) at 6 months, compared with pre-RDN values. LV ejection fraction (LVEF) elevated at 6 months following RDN. In RCTs, however, no significant change in LVMI, E/e’, BNP, left atrial volume index or LVEF was observed at 12 months, compared with pharmaceutical therapy. In summary, both LV hypertrophy and cardiac function improved at 6 months after RDN. Nonetheless, current evidence failed to show that RDN was superior to intensive (optimal) drug therapy in improving cardiac remodeling and function.

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Impact of renal sympathetic denervation on cardiac sympathetic nerve activity evaluated by cardiac MIBG imaging

Abstract: Selective RASD significantly reduces cardiac sympathetic overdrive assessed by 123I-MIBG scintigraphy. Presumably, this positively affects HF progression in patients with resistant arterial hypertension.

Cited by 11 publications

References 23 publications

Modulation of renal sympathetic innervation: recent insights beyond blood pressure control

Modulation of renal sympathetic innervation: recent insights beyond blood pressure control

Renal Sympathetic Denervation in Mild to Moderate Chronic Kidney Disease Patients with Chronic Heart Failure Refractory to Cardiac Resynchronization Therapy: A Safety Evaluation Study

Effects of Renal Denervation on Cardiac Structural and Functional Abnormalities in Patients with Resistant Hypertension or Diastolic Dysfunction

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