Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes

Kiuchi, Márcio Galindo; Silva, Gustavo Ramalho e; Paz, Luis Marcelo Rodrigues; Chen, Shaojie; Souto, Gladyston Luiz Lima

doi:10.1007/s10840-016-0146-1

Cited by 21 publications

(30 citation statements)

References 33 publications

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“…At this point, the results of the proof-of-concept trial SPYRAL HTN-OFF MED suggest efficacy of RDN on BP in the absence of antihypertensive medications [13, 28]. Modulation of the sympathetic nervous system by RDN has been associated with reductions in left ventricular mass, improvements in obstructive sleep apnea severity, and occurrence of arrhythmias [3, 29–32]. A pilot study also demonstrated improved compliance measured by PWV after RDN, suggesting that these parameters better reflect the risk of later cardiac events than the reduction in SBP [33].…”

Section: Discussionmentioning

confidence: 99%

Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

et al. 2018

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Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10−3 mmHg−1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.Electronic supplementary materialThe online version of this article (10.1007/s00392-018-1229-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

et al. 2018

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“…Patients still in AF at the end of the procedure were converted to sinus rhythm by cardioversion. And the RSD procedure has been described in detail previously [25]. The patients remained hospitalized in the ward for 24 h after the procedure.…”

Section: Letters To the Editor | 25mentioning

confidence: 99%

Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

Kiuchi¹,

Chen²

2018

ICFJ

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Accentuated sympathetic nerve activity is a strong danger feature for cardiovascular major episodes, such as cerebral and myocardial ischemia/infarction. Peripheric sympathetic nerve activity is emphasized in the hypertensive state, congestive cardiac failure, OSA, heaviness, diabetes, and chronic kidney disease (CKD) subjects. Leastwise a half of individuals with hypertension present augmented sympathetic nerve activity. Our group believes that RSD can reduce AF recurrence in patients with CKD and OSA by modulation of the sympathetic hyperactivity present in these diseases. The goal of this prospective study was to compare the impact of different treatments including CPAP, PVI, RSD, and some combination of them in controlled hypertensive patients with paroxysmal AF, moderate CKD, and severe OSA. Our data suggest that the patients underwent RSD associated to CPAP treatment or PVI, or both of them presented an improvement in the renal function, a decrease in AHI and a lower chance to present AF recurrence than the ones that did not suffer this intervention. Although encouraging, our data are preliminary and need long-term validation in a large population.

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“…A 3-channel recorder was used to record the electrocardiographic traces, calculate the minimum, mean and maximum HR, the quantity and the morphologies of PVCs at baseline [8]. Polymorphic PVCs were defined as 3 or more PVCs of different morphologies in a high incidence each one [8].…”

Section: -Hour-holter Monitoringmentioning

confidence: 99%

Incidence of sustained ventricular tachycardia and ventricular fibrillation in patients with cardiac scar zones and low vs. normal left ventricular ejection fraction

Kiuchi¹,

Chen²

2017

Cardiovasc Disord Med

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Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes

Abstract: Polymorphic PVCs refractory to medication therapy may be modifiable by RSD in patients without structural heart disease. Although encouraging, our data are preliminary and need to be validated in a large population and in long term.

Cited by 21 publications

References 33 publications

Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial

Different Strategies to Treat Paroxysmal AF in Patients with Moderate CKD and Severe OSA: a sub group Analysis

Incidence of sustained ventricular tachycardia and ventricular fibrillation in patients with cardiac scar zones and low vs. normal left ventricular ejection fraction

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