Objective: The search for the ideal candidate for renal denervation (RDN) is one of the priority treatments of patients with resistant hypertention (RH). Our objective was to identify the predictors of the efficiency of renal denervation. Design and method: The study included 112 patients with RH. The average age of patients was 53 [19; 69] years. Twenty-four (21.4%) patients had atrial fibrillation (AF). Four (16.7%) patients had chronic AF, 8 (33.3%) patients had persistent AF, and 12 (50%) – paroxysmal AF. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex (Medtronic): ablation power = 8 - 10 W at 55°C, 4 – 10 points for each renal artery (including brunches), 2 minutes per point. Office BP and 24-hour ambulatory BP, 24-hour ECG monitoring, arrhythmia chronocard diaries were measured before, at 6 and 12 months of follow-up. A logistic regression analysis included the following parameters: gender, age, body mass index, office and 24-hour ambulatory systolic blood pressure (SBP), diabetes mellitus and the AF presence. Results: baseline office SBP and DBP in patients with RH were 185.4 ± 29.19 and 109.96 ± 17.95 respectively. Office BP decreased by 29.8 /14.1 mmHg at 12 month after RDN (p < 0.001). 24-hour ambulatory SBP decreased from 161.3 ± 25.9 mm Hg to 148.1 ± 21.3 mm Hg at 12 months after the intervention, DBP from 94.3 ± 16.4 mm Hg to 87.2 ± 15.9 mmHg (p < 0,001). It was found that all patients (100%) with RH and AF were responders to renal denervation. This response is defined as a reduction of office SBP of less than 10 mmHg following RDN. Whereas 17.2% of non-AF group patients were non-responders. The number of symptomatic AF paroxysms significantly decreased from 9 [2; 11] to 2 [1; 3] one year after RDN (p = 0.001). Conclusions: Patients with RH and AF are among the best candidates for RDN. It may help to improve the selection of patients with arterial hypertension for the RDN.

Aim. To assess the prevalence of the left ventricle involvement and the features of the biventricular phenotype of arrhythmogenic cardiomyopathy in patients with pathogenic mutations in the PKP2 and DSP genes.Material and methods. Three unrelated probands underwent a comprehensive molecular-genetic, clinical and instrumental examination, which included a 12-lead ECG, 24-hour ECG monitoring, transthoracic echocardiography, and cardiac magnetic resonance imaging with late gadolinium enhancement.Results. The results of our clinical observations showed that in three studied patients with arrhythmogenic cardiomyopathy left ventricle involvement of various degree was found. The left ventricle damage was characterized by fibrous or fibro-fatty infiltration of the myocardium, as well as regional or global systolic dysfunction of different severity. The patients had pathogenic mutations c.1912C > T (p.Gln638*, rs397517012, rs397517012); c.1237C > T (p.Arg413*, rs372827156) in the PKP2 gene and a new probably pathogenic variant in the form of a c.3494delA deletion in the DSP gene. It was found that the mutation in the DSP gene was associated with a more pronounced systolic dysfunction and a greater percentage of fibrous replacement of the left ventricular myocardium compared with carriers of mutations in the PKP2 gene. All patients had life-threatening ventricular arrhythmias with the need for implantation of a cardioverter-defibrillator.Conclusion. Our clinical observations have shown that in patients with biventricular arrhythmogenic cardiomyopathy, the detection of a mutation in the DSP gene is associated with a more pronounced systolic dysfunction and a higher percentage of fibrous replacement of the left ventricle myocardium compared with carriers of mutations in the PKP2 gene.

No abstract

No abstract

No abstract