Catheter-based radiofrequency ablation therapy of the renal sympathetic-nerve system for drug resistant hypertension in a patient with end-stage renal disease

Prochnau, Dirk; Lauten, Alexander; Busch, Martin; Kuehnert, H.; Figulla, Hans R.; Surber, Ralf

doi:10.1016/j.ijcard.2011.05.022

Cited by 18 publications

(16 citation statements)

References 6 publications

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“…27,28 Therefore, RNA seems an attractive option for the inhibition of SNS overactivity in these patients. Indeed, RNA was successful and effective in 2 case reports of patients with ESRD, 71,72 in a larger group of 15 patients with moderate and severe CKD, 48 and in a study of 9 patients with ESRD. 73 Large multicenter studies are currently underway to further evaluate the effects of RNA in CKD.…”

Section: Chronic Kidney Diseasementioning

confidence: 99%

Renal Nerve Ablation for Resistant Hypertension

et al. 2014

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S ympathetic renal denervation, or renal nerve ablation (RNA), has become the new buzz word in hypertension and interventional cardiology. Recent advances in catheterbased approaches have allowed sympathetic fiber interruption through transvascular techniques that are minimally invasive and can be delivered expeditiously and safely. Radiofrequency (RF) energy sources are currently the preferred modalities, but other sources of energy, such as cryoablation, microwave, high-intensity focus ultrasound, and local neurotoxic agent infusion, are under intense investigation. Results thus far have been encouraging and offer promise for the future. The role of the sympathetic nervous system (SNS) in the development of resistant hypertension and cardiovascular disease has long been known, and a great deal of work has been done through the years trying to explore potential interventions to interrupt the sympathetic influence on systemic vasculature and target organs. In this article we attempt an overview of timedependent interventions on the SNS and examine approaches used in humans and in the many experimental models that offer a better understanding of the role of sympathetic activity in cardiovascular disease. Naturally we focus on methods and techniques addressing sympathetic renal denervation in patients with drug-resistant hypertension, examine the current state of the art, and attempt a look into the future. Historic PerspectiveIn 1889, after meticulous experiments on dogs, Bradford 1 reported that stimulation of dorsal and splanchnic nerves causes changes in blood pressure (BP) and kidney size measured by plethysmography. Whether BP increased or decreased depended on the anatomic area stimulated, as well as the electric impulse frequency, but outcomes were consistent and reproducible. Neurosurgical treatment of hypertension was independently suggested by researchers in 1923. Adson, however, was the first to performed surgical sympathectomy for the treatment of malignant hypertension in 1925.3 During the following years and in the 1930s, Peet in Ann Arbor, Page and Heuer in New York, and Adson, Craig, and Brown from the Mayo Clinic operated and reported on series of patients all experiencing malignant hypertension.4 At the same time, renal decapsulation, which was considered a form of sympathectomy by disrupting the fibers between the capsule and the renal cortex, was being performed to treat unexplained hematuria and perinephritis. Sen 5 reported a significant but not permanent decrease in BP in 85 subjects who underwent decapsulation between 1925 and 1935.Surgical denervation of the kidneys alone was first performed in humans by Papin and Ambard 6 in 1924 in an attempt to relieve intractable pain originating from the kidney. The first case of bilateral sympathetic denervation of the kidney to treat severe essential hypertension was presented in 1934 by Page and Heuer. 7 The patient was a 25-year-old woman who reported easy fatigability and had severe headaches and BP in the range of 208/140 mm Hg. The patient und...

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Section: Chronic Kidney Diseasementioning

confidence: 99%

Renal Nerve Ablation for Resistant Hypertension

et al. 2014

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“…At six weeks after surgery, the expression of TLR4, NF-κB, TNF-α and IL-6 in the D2 group was only slightly higher than that in the D0 group (p>0.05) but markedly lower than that in the S2 group (p<0.05) (Table 2, Figure 4). In recent years, treatment of hypertension and diseases due to chronic hyperactivity sympathetic nervous system (such as heat failure, hypertension accompanied by impaired glucose tolerance and chronic renal dysfunction) with RDN has been a hot topic in the research [8][9][10] . Krum et al 6 found that RDN not only reduced the blood pressure, but conferred protective effect on hypertension induced LVH, but the mechanism was still unclear.…”

Section: Western Blot Assay For Tlr4 Nf-κb Tnf-α and Il-6mentioning

confidence: 99%

Effect of renal denervation procedure on left ventricular hypertrophy of hypertensive rats and its mechanisms

Jiang

Tan²,

Guo³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To investigate the effect of renal denervation (RDN) on the blood pressure, left ventricular hypertrophy and myocardial expression of TLR4/NF-κB in spontaneously hypertensive rats (SHR). METHODS: A total of 36 SHR were randomly assigned into control group (D0), RDN group (D) and sham group (S). 12 WKY rats of same age served as controls (WKY group). Rats in the D0 and WKY groups were sacrificed, but rats in the D and S group were sacrificed at one week and six weeks after surgery. The heart was collected and the left ventricle weighted followed by calculation of left ventricular mass index (LVMI). RESULTS: In the D0 group, the blood pressure, LVMI and protein expression of TLR4, NF-κB, TNF-α and IL-6 in the myocardium were markedly higher than that in the WKY group (p<0.05). In the D1 and D2 group, the LVMI, NE and protein expression of TLR4, NF-κB, TNF-α and IL-6 in the myocardium were significantly reduced (p<0.05). CONCLUSION: Renal denervation can significantly delay the progression of left ventricular hypertrophy in spontaneously hypertensive rats, which may be attributed to the not only the suppression of sympathetic activity and attenuation of pressure load but the improvement of myocardial immuno-inflammation. Key words: Denervation. Kidney. Hypertrophy, Left Ventricular. Toll-Like Receptor 4. Ventricular Remodeling. Norepinephrine. Rats. RESUMO OBJETIVO:Investigar o efeito da denervação renal na pressão sanguínea, na hipertrofia do ventrículo esquerdo e a expressão miocárdica de TLR4/NF-kB em ratos espontaneamente hipertensos. MÉTODOS: Trinta e seis SHR ratos foram aleatoriamente distribuídos em grupo controle, grupo denervação renal (D) e grupo sham(S).12 WKY ratos de mesma idade serviram de controle. Os ratos controles foram sacrificados, mas os ratos com denervação renal e sham foram sacrificados uma semana e seis semanas após a cirurgia. O coração foi retirado e o ventrículo esquerdo pesado seguido pelo cálculo da massa ventricular (LVMI). RESULTADOS:No grupo DO, a pressão sanguínea, LVMI e a expressão proteica de TLR4, NF-κB, TNF-α e IL-6, no miocárdio foram marcadamente maiores do que o grupo WKY (p<0,05). Nos grupos D1 e D2, o LVMI, NE e a expressão proteica de TLR4, NF-κB, TNF-α e IL-6 no miocárdio foi significantemente reduzido (p<0,05). CONCLUSÃO: A denervação renal pode significantemente retardar a progressão da hipertrofia ventricular esquerda em ratos espontaneamente hipertensos, o que pode ser atribuído não apenas pela supressão da atividade simpática e atenuação da pressão, mas pela melhora na imunoinflamação miocárdica.

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“…A critical factor in resistant HTN is the hyperactivity of the sympathetic nervous system, which increases progressively and in parallel with HTN stages, indicating that more advanced stages of HTN have a greater adrenergic activity [2]. Recent research could show that catheter-based renal sympathetic denervation is effective in BP lowering in patients with resistant hypertension [3][4][5][6][7]. Usually, a special ablation catheter (Symplicity®, Flex-Catheter, Medtronic/Ardian Inc. USA) is used for this purpose.…”

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confidence: 99%

“…The progress in the cancer knowledge and treatment has led to a new frontier: the cardio-oncology [1][2][3][4][5][6][7][8][9][10]. Cancer patients can benefit from an open dialogue between both cardiologists and oncologists [2].…”

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