Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients

Tsioufis, Κonstantinos; Feyz, Lida; Dimitriadis, Kyriakos; Konstantinidis, Dimitris; Tousoulis, Dimitrios; Voskuil, Michiel; Mahfoud, Felix; Daemen, Joost

doi:10.4244/eij-d-18-00536

Cited by 21 publications

(12 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While PVI has been well recognized as an established ablation approach with clear endpoint using either radiofrequency or cryoenergy in treating AF, RDN currently on the other hand remains at a stage of “blinded ablation.” Several factors such as patient selection, baseline BP patterns, antihypertensive medications, comorbidities, ablation devices, and acute BP response have been reported to be related to the response of RDN . At technique level, electrical stimulation at intraluminal renal artery using electrical catheter aiming at inducing BP elevation measured before and after the ablation procedure has been used to assess the extent of denervation . The stimulation technique may be used as a practical approach to map the renal autonomic nerves adjacent to renal artery and as a guidance to perform “selective renal sympathetic nerve ablation.”…”

Section: Discussionmentioning

confidence: 99%

“…53 level, electrical stimulation at intraluminal renal artery using electrical catheter aiming at inducing BP elevation measured before and after the ablation procedure has been used to assess the extent of denervation. [56][57][58][59][60] The stimulation technique may be used as a practical approach to map the renal autonomic nerves adjacent to renal artery and as a guidance to perform "selective renal sympathetic nerve ablation. "…”

Section: Ablation Technique Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Chen

Kiuchi

Yin

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction Disturbance of sympathetic and vagal nervous system participates in the pathogenesis of hypertension and atrial fibrillation (AF). Renal denervation (RDN) can modulate autonomic nervous activity and reduce blood pressure (BP) in hypertensive patients. We aimed to evaluate the effect of RDN combined with pulmonary vein isolation (PVI) in patients with AF and hypertension. Methods Clinical trials including randomized data comparing PVI plus RDN vs PVI alone were enrolled. Primary outcome was incidence of AF recurrence after procedure. Results A total of 387 patients, of them 252 were randomized and were enrolled. Mean age was 57 ± 10 years, 71% were male, and mean left ventricular ejection fraction was 57.4% ± 6.9%. Follow‐up for randomized data was 12 months. Overall comparison for primary outcome showed that PVI + RDN was associated with significantly lower AF recurrence as compared with PVI alone (35.8% vs 55.4%, P < 0.0001). This advantageous effect was consistently maintained among randomized patients (37.3% vs 61.9%, odds ratio = 0.37, P = 0.0001), and among patients with implanted devices for detection of AF recurrence (38.9% vs 61.6%, P = 0.007). Post‐hoc sensitivity and regression analysis demonstrated very good stability of this primary result. Pooled Kaplan‐Meier analysis further showed that PVI + RDN was associated with significantly higher freedom from AF recurrence as compared with PVI alone (log‐rank test, P = 0.001). Besides, RDN resulted in significant BP reduction without additionally increasing the risk of adverse events. Conclusions RDN may provide synergetic effects with PVI to reduce the burden of AF and improve BP control in patients with AF and uncontrolled hypertension.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Ablation Technique Considerationsmentioning

confidence: 99%

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Chen

Kiuchi

Yin

et al. 2019

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Direct nerve stimulation during RDN offers a method of discrimination between inhibitory and stimulatory fibers and has shown initial promise in animal models as well as small human pilot studies. 74 , 75…”

Section: Device-based Therapiesmentioning

confidence: 99%

Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Pathan¹,

Cohen²

2020

IBPC

View full text Add to dashboard Cite

“…Novel technologies are providing insights into how to achieve successful ablation procedure through renal nerve mapping but presently add considerably to time spent on the table in the catheter lab and their value is undetermined 50…”

Section: The Juks Updated Perspective On Rdnmentioning

confidence: 99%

Joint UK societies’ 2019 consensus statement on renal denervation

Lobo

Sharp

Kapil

et al. 2019

Heart

View full text Add to dashboard Cite

Improved and durable control of hypertension is a global priority for healthcare providers and policymakers. There are several lifestyle measures that are proven to result in improved blood pressure (BP) control. Moreover, there is incontrovertible evidence from large scale randomised controlled trials (RCTs) that antihypertensive drugs lower BP safely and effectively in the long-term resulting in substantial reduction in cardiovascular morbidity and mortality. Importantly, however, evidence is accumulating to suggest that patients neither sustain long-term healthy behaviours nor adhere to lifelong drug treatment regimens and thus alternative measures to control hypertension warrant further investigation. Endovascular renal denervation (RDN) appears to hold some promise as a non-pharmacological approach to lowering BP and achieves renal sympathectomy using either radiofrequency energy or ultrasound-based approaches. This treatment modality has been evaluated in clinical trials in humans since 2009 but initial studies were compromised by being non-randomised, without sham control and small in size. Subsequently, clinical trial design and rigour of execution has been greatly improved resulting in recent sham-controlled RCTs that demonstrate short-term reduction in ambulatory BP without any significant safety concerns in both medication-naïve and medication-treated hypertensive patients. Despite this, the joint UK societies still feel that further evaluation of this therapy is warranted and that RDN should not be offered to patients outside of the context of clinical trials. This document reviews the updated evidence since our last consensus statement from 2014 and provides a research agenda for future clinical studies.

show abstract

Safety and performance of diagnostic electrical mapping of renal nerves in hypertensive patients

Cited by 21 publications

References 18 publications

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Synergy of pulmonary vein isolation and catheter renal denervation in atrial fibrillation complicated with uncontrolled hypertension: Mapping the renal sympathetic nerve and pulmonary vein (the pulmonary vein isolation plus renal denervation strategy)?

Resistant Hypertension: Where are We Now and Where Do We Go from Here?

Joint UK societies’ 2019 consensus statement on renal denervation

Contact Info

Product

Resources

About