The Potential Role of Renal Denervation in the Management of Heart Failure

Abstract

Sympathetic nervous system activation in patients with heart failure is one of the main pathophysiologic mechanisms associated with the worse outcomes. Pharmacotherapies targeting neurohormonal activation have been at the center of heart failure management. Despite the advancement of therapies and the available treatments, heart failure continues to have an overall poor prognosis. Renal denervation was originally developed to lower systemic blood pressure in patients with poorly controlled hypertension, by modulating sympathetic outflow. However, more recently, multiple studies have investigated the effect of renal denervation in heart failure patients with both preserved (HFpEF) and reduced ejection fractions (HFrEF). This paper provides an overview of the potential effect of renal denervation in altering the various pathophysiologic, sympathetically mediated pathways that contribute to heart failure, and reviews the literature that supports its future use in those patients.

Impact of renal denervation on cardiac remodeling in resistant hypertension: A meta‐analysis

“… 31 RDN can also reduce the activation of the sympathetic nervous system throughout the whole body, as renal sympathetic afferent nerves play an important role in stimulating the activity of the hypothalamic sympathetic nervous system. 32 Moreover, studies have shown that besides its role in treating RH, RDN may also be effective in the management of other diseases associated with excessive activation of the sympathetic nervous system, such as congestive heart failure, 33 atrial fibrillation, 34 obstructive sleep apnea syndrome. 35 Therefore, the benefits of RDN may be pleiotropic, including attenuating overactivation of the sympathetic nervous system, lowering blood pressure, and improving cardiac arrhythmias, and so forth.…”

The Sympathetic Nervous System in Hypertensive Heart Failure with Preserved LVEF

“…Considering the tight interactions between HHF with preserved LVEF, HTN, and renal sympathetic activity, renal denervation has been promoted as a rational therapeutic approach in this patient population [104,105] (Figure 5). As the results of preliminary studies have been encouraging, renal denervation may prove useful in the management of patients with HHF and preserved LVEF, providing optimization of patient selection and improvement in ablation strategies [106].…”

“…Figure 5. Neurohormonal pathways connecting the renal system to the central nervous system, cardiac, and vascular systems and the effect of renal denervation on those pathways (red arrows).permission from ref [105]…”