Renal denervation

Olsen, Lene Kjær; Kamper, Anne-Lise; Svendsen, Jesper Hastrup; Feldt‐Rasmussen, Bo

doi:10.1016/j.ejim.2015.01.009

Cited by 7 publications

(7 citation statements)

References 115 publications

(147 reference statements)

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“…(7) The patient population in some trials are heterogenous and propensity scores were not matched to minimise confounding factors. (8) The inclusion of several types of arrhythmia as an outcome did not allow us to interpret the outcomes of each arrhythmia individually for a minuscule portion of the analysis. Lastly, the reporting of arrhythmia recurrence was variable which made it difficult for us to pool data and to quantify the difference from various studies for analysis.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of renal denervation for the management of cardiac arrhythmias

et al. 2021

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Background In the wake of the controversy surrounding the SYMPLICITY HTN-3 trial and data from subsequent trials, this review aims to perform an updated and more comprehensive review of the impact of renal sympathetic denervation on cardiac arrhythmias. Methods and results A systematic search was performed using the Medline, Scopus and Embase databases using the terms “Renal Denervation” AND “Arrhythmias or Atrial or Ventricular”, limited to Human and English language studies within the last 10 years. This search yielded 19 relevant studies (n = 6 randomised controlled trials, n = 13 non-randomised cohort studies) which comprised 783 patients. The studies show RSD is a safe procedure, not associated with increases in complications or mortality post-procedure. Importantly, there is no evidence RSD is associated with a deterioration in renal function, even in patients with chronic kidney disease. RSD with or without adjunctive pulmonary vein isolation (PVI) is associated with improvements in freedom from atrial fibrillation (AF), premature atrial complexes (PACs), ventricular arrhythmias and other echocardiographic parameters. Significant reductions in ambulatory and office blood pressure were also observed in the majority of studies. Conclusion This review provides evidence based on original research that ‘second generation’ RSD is safe and is associated with reductions in short-term blood pressure and AF burden. However, the authors cannot draw firm conclusions with regards to less prominent arrhythmia subtypes due to the paucity of evidence available. Large multi-centre RCTs investigating the role of RSD are necessary to comprehensively assess the efficacy of the procedure treating various arrhythmias. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Systematic review of renal denervation for the management of cardiac arrhythmias

et al. 2021

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“…Anatomical variation can affect the protocol and the treatment effect of catheter-based RDN 6,7 . Considering severe vascular complications, catheter-based RDN may be useful only at a renal artery with a diameter of 3 mm or more 6,[9][10][11] . However, most of the large-scale catheter-based denervation trials that evaluated arterial anatomy using conventional angiography were likely to result in poor screening for eligibility 17,18 .…”

Section: Discussionmentioning

confidence: 99%

“…variations might affect the efficacy of denervation 6,[9][10][11] . Previous clinical trials relied on conventional angiography to evaluate this arterial anatomy, and screening failure due to vascular anatomy was < 10% [12][13][14] .…”

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confidence: 99%

Quantitative analysis of renal arterial variations affecting the eligibility of catheter-based renal denervation using multi-detector computed tomography angiography

Song

Baik

Choi

et al. 2020

Sci Rep

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Catheter-based renal denervation (RDN) was introduced to treat resistant hypertension. However, the reduction in blood pressure after the RDN was modest. Catheter-based RDN was performed only at main renal arteries, except for accessory and branch arteries due to the diameter being too small for the catheter to approach. Here, we retrospectively analyzed the anatomy of diverse renal arteries via 64-channel multi-detector computed tomography angiograms of 314 consecutive donors who underwent living donor nephrectomy from January 2012 to July 2017. Occurrence rates of one or more accessory renal arteries in donors were 25.3% and 19.4% on the left and right sides, respectively. Early branching rates before 25 mm from the aorta to the right and left renal arteries were 13.7% and 10.5%, respectively. Overall, 63.1% and 78.3% of donors had no accessory artery bilaterally and no branched renal artery, respectively. As a result, 47.1% had only main renal arteries without an accessory artery and early-branching artery. Approximately half of the donors had multiple small renal arteries bilaterally, for which catheter-based denervation may not be suitable. Thus, preoperative computed tomography angiography requires careful attention to patient selection, and there is a need for improved methods for denervation at various renal arteries.

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“…Careful selection of truly eligible patients, thorough follow-up and treatment adjustment, novel RDN technology used by experienced operators in addition to new, large, well-designed randomized clinical trials, may be the key to success of the procedure in resistant arterial hypertension as well as multiple cardiac and non-cardiac morbidities [ 22 , 23 ]. Furthermore, the use of novel anesthetics, and the use of MIBG may be also helpful, with the latter needing further research in order to document its role in improving RDN success.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG)

Ziakas

Petroglou

Moralidis

et al. 2016

TOCMJ

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Background:The Symplicity-HTN 3 trial failed to show significant difference in blood pressure (BP) lowering between patients undergoing catheter-based renal denervation (RDN) and the sham-procedure arm of the study. However, there is still optimism about the role of RDN in the treatment of resistant hypertension, because identification of patients with increased sympathetic activity thus being good RDN responders, improvements in the RDN procedure and new technology RDN catheters are all expected to lead to better RDN results. We present our initial experience with RDN for the treatment of resistant hypertension, and the utility of novel anesthetics and cardiac 123I-metaiodobenzylguanidine scintigraphy (123I-MIBG).Methods and Results:Seven patients with resistant hypertension underwent RDN and were followed up for 6 months. MIBG was performed before RDN, in order to estimate sympathetic activity and predict the response to RDN. All patients were sedated with dexmedetomidine and remifentanil during RDN. All patients tolerated the procedure well, were hemodynamically stable and their peri-procedural pain was effectively controlled. A median of 7.6 ± 2.1 and 6 ± 1.4 ablations were delivered in the right and left renal artery respectively, making an average of 6.8 burns per artery. No peri-procedural or late complications - adverse events (local or systematic) occurred. At 6 months, mean reduction in office BP was -26.0/-16.3 mmHg (p=0.004/p=0.02), while mean reduction in ambulatory BP was -12.3/-9.2 mmHg (p=0.118/p=0.045). One patient (14.3%) was a non-responder. None of the cardiac 123I-MIBG imaging indexes(early and late heart-to-mediastinum (H/M) count density ratio, washout rate (WR) of the tracer from the myocardium) were different between responders and non-responders.Conclusion:Patients with resistant hypertension who underwent RDN in our department had a significant reduction in BP 6 months after the intervention. 123I-MIBG was not useful in predicting RDN response. Dexmedetomidine and remifentanil provided sufficient patient comfort during the procedure, allowing an adequate number of ablations per renal artery to be performed, and this could probably lead to improved RDN results.

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Renal denervation

Cited by 7 publications

References 115 publications

Systematic review of renal denervation for the management of cardiac arrhythmias

Systematic review of renal denervation for the management of cardiac arrhythmias

Quantitative analysis of renal arterial variations affecting the eligibility of catheter-based renal denervation using multi-detector computed tomography angiography

Initial Experience with Renal Denervation for the Treatment of Resistant Hypertension - The Utility of Novel Anesthetics and Metaiodobenzylguanidine Scintigraphy (MIBG)

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