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

Should We Be Ablating the Kidneys or the Heart to Prevent Arrhythmias?

“…Theoretically, RDN should be beneficial, and this benefit can be achieved without the complications or side effects typically associated with more excessive antisympathetic strategies (e.g., sympathectomy). Furthermore, reduction of sympathetic activity by RDN should have favorable action on ventricular arrhythmias 7 , 8 , as demonstrated in small clinical studies 9 , 10 and case reports 11 , 12 .…”

Cardiac arrhythmias in arterial hypertension

“…Anti‐arrhythmic drug therapy for the treatment of ventricular arrhythmias should be started as a second line option, on an individualized basis, taking into consideration that many anti‐arrhythmics are contraindicated in severe LVH, as stated above. Finally, available data suggest a possible beneficial role for renal sympathetic denervation in reducing the arrhythmic burden and, more specifically, VT episodes in hypertensives with ischemic heart failure or the total number of ventricular arrhythmias in patients with resistant hypertension 4 . Although pathophysiological mechanisms have been proposed, as modulation of sympathovagal balance and reduction of sympathetic activity and angiotensin II levels, robust data derived from adequately powered, high‐quality clinical trials are lacking.…”

“…Hypertensive heart disease is characterized by structural changes and left ventricular hypertrophy (LVH), 3 subsequent electrophysiological alterations in ventricular and atrial myocardial tissue, which can lead to the manifestation of various bradyarrhythmias, supraventricular premature beats, and atrial tachyarrhythmias, in particular atrial fibrillation (AF), ventricular arrhythmias, and sudden cardiac death (SCD). Moreover, considering the crucial role of the increased sympathetic system activation in the pathogenesis of various cardiac arrhythmias, available data suggest that antihypertensive therapies, such as renal sympathetic denervation, might reduce the burden of atrial and ventricular arrhythmias, by modulation of the sympathetic activity, although this needs further investigation 4 . Finally, various antihypertensive agents prescribed for the management of hypertensive patients can contribute to the manifestation of arrhythmias, mainly through electrolyte disturbances.…”

Systematic review of renal denervation for the management of cardiac arrhythmias

“…RSD has also proven to have a role in several related conditions in which the autonomic nervous system plays an important role, such as heart failure, chronic kidney disease (CKD) and glucose metabolism [8,15]. Thus, RSD empirically has a plausible biological mechanism to affect the autonomic nervous system, feedback onto the cardiovascular system, and together with early studies [14] hinting at a possible antiarrhythmic effect. Thus, the results of HTN-3 trial [16] that found that both the RSD and control groups showed similar BP reductions at 6 months, do not directly affect the potential of RSD in treating cardiac arrhythmias.…”