Renal Denervation: Is It Ready for Prime Time?

Lauder, Lucas; Wolf, Milan; Scholz, Sean S.; Hohl, Mathias; Mahfoud, Felix; Böhm, Michael

doi:10.1007/s11886-019-1164-2

Cited by 12 publications

(10 citation statements)

References 59 publications

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“…Renal denervation (RDN) is associated with a reduction of central sympathetic activity 16,17 and represents a device-based therapy for patients with uncontrolled hypertension 18,19 and AF. 20 Beyond blood pressure, experimental animal studies suggest RDN to reduce atrial fibrosis and subsequently inhibit AF inducibility and complexity in animals without renal failure.…”

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confidence: 99%

Renal Denervation Prevents Atrial Arrhythmogenic Substrate Development in CKD

Hohl

Selejan

Wintrich

et al. 2022

Circulation Research

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Background: In patients with chronic kidney disease (CKD), atrial fibrillation (AF) is highly prevalent and represents a major risk factor for stroke and death. CKD is associated with atrial proarrhythmic remodeling and activation of the sympathetic nervous system. Whether reduction of the sympathetic nerve activity by renal denervation (RDN) inhibits AF vulnerability in CKD is unknown. Methods: Left atrial (LA) fibrosis was analyzed in samples from patients with AF and concomitant CKD (estimated GFR, <60 mL/min per 1.73 m 2 ) using picrosirius red and compared with AF patients without CKD and patients with sinus rhythm with and without CKD. In a translational approach, male Sprague Dawley rats were fed with 0.25% adenine (AD)-containing chow for 16 weeks to induce CKD. At week 5, AD-fed rats underwent RDN or sham operation (AD). Rats on normal chow served as control. After 16 weeks, cardiac function and AF susceptibility were assessed by echocardiography, radiotelemetry, electrophysiological mapping, and burst stimulation, respectively. LA tissue was histologically analyzed for sympathetic innervation using tyrosine hydroxylase staining, and LA fibrosis was determined using picrosirius red. Results: Sirius red staining demonstrated significantly increased LA fibrosis in patients with AF+CKD compared with AF without CKD or sinus rhythm. In rats, AD demonstrated LA structural changes with enhanced sympathetic innervation compared with control. In AD, LA enlargement was associated with prolonged duration of induced AF episodes, impaired LA conduction latency, and increased absolute conduction inhomogeneity. RDN treatment improved LA remodeling and reduced LA diameter compared with sham-operated AD. Furthermore, RDN decreased AF susceptibility and ameliorated LA conduction latency and absolute conduction inhomogeneity, independent of blood pressure reduction and renal function. Conclusions: In an experimental rat model of CKD, RDN inhibited progression of atrial structural and electrophysiological remodeling. Therefore, RDN represents a potential therapeutic tool to reduce the risk of AF in CKD, independent of changes in renal function and blood pressure.

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confidence: 99%

Renal Denervation Prevents Atrial Arrhythmogenic Substrate Development in CKD

Hohl

Selejan

Wintrich

et al. 2022

Circulation Research

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“…Совершенствуется техника вмешательства: проведение процедуры в дистальных ветвях почечных артерий. Подают надежду 2 исследования: SPYRAL PIVOTAL и RADIANCE II [12,13]. В случае данной пациентки нами рассмотрена возможность выполнения радиочастотной аблации почечных артерий.…”

Section: Discussionunclassified

The clinical case of successful combined treatment of refractory arterial hypertension. Case report

Solntseva

Дмитриевна²,

Denisova

et al. 2021

Terapevticheskii arkhiv

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In recent years, there has been an increase of patients with arterial hypertension, one of the variants of which is refractory arterial hypertension. This unfavorable clinical variant of the course of hypertension worries clinicians, due to the higher risk of developing cardiovascular complications, realizing the need for a better control of blood pressure. The presented clinical case demonstrates the successful combined treatment of refractory hypertension using antihypertensive therapy and renal denervation.

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“…Similar to physiological assessment of flow and flow reserve in the coronary arteries, renal flow reserve may become useful in this setting [ 2 ]. Although this issue still has not been solved, recent randomised sham-controlled trials (DENERHTN, SPYRAL HTN-ON MED, SPYRAL HTN-OFF MED, RADIANCE HTN SOLO) have sparked renewed interest because they demonstrated clinically significant reduction of ambulatory blood pressure in comparison with control groups [ 3 ]. More effective RDN may be related to second-generation radiofrequency (RF) ablation catheter systems (including Symplicity Spyral RF-RDN, Medtronic Vascular, Santa Rosa, CA, USA), ultrasound catheter systems (including ReCor Medical, Palo Alto, CA, USA), and combining ablation in the proximal renal artery and peripheral branches [ 4 ].…”

Section: So Does Rdn Have a Future Role To Play In The Treatment Of O...mentioning

confidence: 99%

Renal denervation revisited; should we pay attention?

Winter

2022

Neth Heart J

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In this issue of the journal, L. Feyz and colleagues present the results of a small, randomised study investigating the safety and efficacy of renal denervation (RDN) in patients with heart failure and reduced ejection fraction [1]. Primary safety endpoint was the combination of cardiovascular death, rehospitalisation for heart failure, and acute kidney injury at 6 months. Efficacy was defined as the change in iodine-123 labelled meta-iodobenzylguanidine ( 123 I-MIBG) heart-to-mediastinum ratio at 6 months. The authors demonstrate that RDN with the Vessix V2 Renal Denervation System (Boston Scientific, Natick, MA, USA) was safe, but the primary efficacy endpoint was not different when comparing the RDN treated patients with the patients treated with optimal medical therapy.The study was small, only 50 patients, less than the anticipated 71 patients. However, collecting these data has been the result of a major endeavour. The study group screened 343 eligible patients over a period of 4 years. Patients randomised to RDN underwent the invasive procedure and all patients underwent MIBG scanning, with subsequent meticulous follow-up for 6 months to assess outcomes. It is important that neutral or negative studies, albeit small, are published for readers to appreciate the outcomes as well as to prevent scientific information to become inadvertently skewed to positive results. R. J. de Winter ( )

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Renal Denervation: Is It Ready for Prime Time?

Cited by 12 publications

References 59 publications

Renal Denervation Prevents Atrial Arrhythmogenic Substrate Development in CKD

Renal Denervation Prevents Atrial Arrhythmogenic Substrate Development in CKD

The clinical case of successful combined treatment of refractory arterial hypertension. Case report

Renal denervation revisited; should we pay attention?

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