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.

Background: The perioperative use of antithrombotic therapy is associated with increased bleeding risk after cardiac implantable electronic device (CIED) implantation. Topical application of tranexamic acid (TXA) is effective in reducing bleeding complications after various surgical operations. However, there is no information regarding local TXA application during CIED procedures. The purpose of our study was to evaluate major bleeding complication rates during CIED implantation with and without topical TXA use in patients receiving antithrombotic treatment. Methods: We conducted a retrospective analysis of consecutive patients undergoing CIED implantation while receiving warfarin or dual antiplatelet (DAPT) or warfarin plus DAPT treatment. Study population was divided in two groups according to presence or absence of topical TXA use during CIED implantation. Major bleeding complications (MBC) defined as any bleeding leading to transfusion, surgical intervention for pocket evacuation or revision, pericardial effusion, hemothorax, or life-threatening bleed. Thromboembolic events were defined as transient ischemic attack, stroke, myocardial infarction, deep vein thrombosis, and pulmonary embolism within 90 days of procedure. Results: A total of 135 consecutive patients were identified and included in the analysis. The mean age was 60 years old. Topical TXA application during implantation was reported in 52 patients (TXA group). The remaining 83 patients were assigned to the control group. The major bleeding complication rate was lower in TXA group compared to control group (5.8% vs 20.5%, P ¼ 0.024). Univariate logistic regression analysis identified history of recent stent implantation, perioperative warfarin use, perioperative warfarin plus DAPT use and topical TXA application during CIED procedure as predicting factors of MBC (Tabel 1). Multivariate analysis of factors with P , 0.1 in univariate analysis showed that perioperative warfarin plus DAPT use (OR ¼ 8.144, 95% CI: 2.589-25.618, P , 0.001) and topical TXA application during CIED procedure (OR ¼ 0.170, 95% CI: 0.042-0.690, P ¼ 0.013) were independent predictors of MBC. No thromboembolic complications was recorded in the study group.Conclusion: The present study demonstrated for the first time that the topical TXA application during CIED implantation is associated with reduced MBC in patients with high bleeding risk. Backgrounds: It have been published recently several articles demonstrating the effectiveness of renal denervation (RDN) in patients with arterial hypertension (AH) and ventricular arrhythmias due to reduction of systemic sympathetic tone. Results: In 2010, a 55 year-old patient with arrhythmogenic right ventricular dysplasia (ARVD) and AH with recurred sustained ventricular tachycardia (VT) was implanted cardioverter -defibrillator (ICD). In 2011, radiofrequency ablation (RFA) of VT was performed. The patient had appropriate multiple recurrent ICD shocks that required 3 hospitalization during 2013 year. Quality of life of the patient has de...