Renal denervation decreases effective refractory period but not inducibility of ventricular fibrillation in a healthy porcine biomodel: a case control study

Abstract

BackgroundVentricular arrhythmias play an important role in cardiovascular mortality especially in patients with impaired cardiac and autonomic function. The aim of this experimental study was to determine, if renal denervation (RDN) could decrease the inducibility of ventricular fibrillation (VF) in a healthy porcine biomodel.MethodsControlled electrophysiological study was performed in 6 biomodels 40 days after RDN (RDN group) and in 6 healthy animals (control group). The inducibility of VF was tested by programmed ventricular stimulation from the apex of right ventricle (8 basal stimuli coupled with up to 4 extrastimuli) always three times in each biomodel using peripheral extracorporeal oxygenation for hemodynamic support. Further, basal heart rate (HR), PQ and QT intervals and effective refractory period of ventricles (ERP) were measured. Technical success of RDN was evaluated by histological examination.ResultsAccording to histological findings, RDN procedure was successfully performed in all biomodels. Comparing the groups, basal HR was lower in RDN group: 79 (IQR 58; 88) vs. 93 (72; 95) beats per minute (p = 0.003); PQ interval was longer in RDN group: 145 (133; 153) vs. 115 (113; 120) ms (p < 0.0001) and QTc intervals were comparable: 402 (382; 422) ms in RDN vs. 386 (356; 437) ms in control group (p = 0.1). ERP was prolonged significantly in RDN group: 159 (150; 169) vs. 140 (133; 150) ms (p = 0.001), but VF inducibility was the same (18/18 vs. 18/18 attempts).ConclusionsRDN decreased the influence of sympathetic nerve system on the heart conduction system in healthy porcine biomodel. However, the electrophysiological study was not associated with a decrease of VF inducibility after RDN.

Renal Denervation for Ventricular Arrhythmia in Patients with Implantable Cardioverter Defibrillators

“…[16][17][18] Effects of RDN on trigger arrhythmias are also available from animal experiments. 7,19) RDN can even directly increase the ventricular effective refractory period 20,21) and action potential duration. 20) Aside from immediate antiarrhythmic properties, RDN ameliorates the symptoms of chronic heart failure and therefore eliminates VAs during a long-term follow up.…”

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

“…However, the results of these trials do not directly affect the potential beneficial effects of RDN on cardiac arrhythmias. RDN affects the cardiac conduction system as well the other structural components of the heart [12,15,25,37]. Of note, patients with resistant hypertension who are RDN BP responders show greater HR reduction and attenuation of atrial and ventricular ectopic activity although the impact of HR reduction on patient outcomes remains unclear [39].…”

“…Specifically, electrophysiological studies in 6 biomodels after 40 days of RDN were compared to those of 6 healthy animals (control group) [12]. In the RDN group basal heart rate (HR) was lower, PQ interval was longer, QTc intervals were comparable while effective refractory period (ERP) was prolonged significantly compared to control group.…”

“…ACCEPTED MANUSCRIPT 12 infarction who treated with thrombus aspiration and PCI. After the initial treatment, the patient developed recurrent monomorphic VT and VF episodes (electrical storms) refractory to antiarrhythmic drug therapy that recurred after VT ablation.…”

“…On the other hand, in a HF canine model, RDN showed to shorten the mean QT and QTc dispersion during sinus rhythm [8]. However, in a porcine biomodel the ERP shortening that was observed after RDN was not associated with decreased VF inducibility [12]. Additionally, it has been showed that RDN attenuates the increase of P-wave duration and dispersion induced by long-term intermittent atrial pacing which may be associated with reduce incidence of paroxysmal AF [15].…”