Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension

Kiuchi, Márcio Galindo; Maia, George Luiz Marques; Carreira, Maria Angela Magalhães de Queiroz; Kiuchi, Tetsuaki; Chen, Shaojie; Andréa, Bruno Rustum; Graciano, Miguel Luis; Lugon, Jocemir Ronaldo

doi:10.1093/eurheartj/eht200

Cited by 80 publications

(82 citation statements)

References 33 publications

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“…As we described previously [5,6], the reduction in office BP was evident from the 1st month until one year after RSD in refractory hypertensive patients. A recent study in animals showed the pathology of radiofrequencyderived RSD during the time and provided important knowledge of the mechanisms resulting in sustained BP reduction, and reported that the nerve damage post radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained ≤30 days.…”

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confidence: 69%

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

Kiuchi¹,

Chen²

2017

J Integr Cardiol

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Studies employing percutaneous renal sympathetic denervation (RSD) [1][2][3][4] showed a reduction in both systolic and diastolic blood pressure (BP) among refractory hypertensive patients. As we described previously [5,6], the reduction in office BP was evident from the 1st month until one year after RSD in refractory hypertensive patients. A recent study in animals showed the pathology of radiofrequencyderived RSD during the time and provided important knowledge of the mechanisms resulting in sustained BP reduction, and reported that the nerve damage post radiofrequency ablation was greatest at 7 days, with maximum functional nerve damage sustained ≤30 days. Focal terminal nerve regeneration was observed only at the sites of ablation as early as 2 months and continued to 6 months [7]. Another study reported a substantial decrease in office systolic BP in relation to the number of ablation points at 6 months [8]. To date, there is no test to prove the acute efficacy of RSD.As a hormone, epinephrine plays on closely all body tissues. Its actions vary by tissue kind and tissue manifestation of adrenergic receptors. Epinephrine acts by binding to a diversity of adrenergic receptors. Epinephrine is a nonselective agonist of altogether adrenergic receptors, comprising the major subtype's α 1 , α 2 , β 1 , β 2 , and β 3 . Its activities are to increase peripheral resistance via α1 receptordependent vasoconstriction and to growth cardiac output via its binding to β1 receptors. Based on this information, we believe that epinephrine can be used to evaluate the acute response of BP and heart rate (HR) to RSD in uncontrolled hypertensive patients.This transversal study involved 25 uncontrolled hypertensive subjects, was conducted in agreement with the Helsinki declaration and approved by the ethics committee of our institution. All subects sign up the informed consent term before inclusion. This study was piloted at the Hospital e Clínica São Gonçalo, Rio de Janeiro, Brazil. Patients were recruited from January 2015 to December 2016 from the Arrhythmias and Artificial Cardiac Pacing Service of the same hospital. Patients with the mixture of the subsequent criteria were successively enrolled: (i) mean 24-hour systolic ambulatory BP measurements (ABPM) of >130 mmHg and mean 24-hour diastolic ambulatory BP >80 mmHg, in use of at least 3 antihypertensive agents in the maximum doses prescribed or tolerated, being one of them a diuretic; (ii) a physically normal heart with an ejection fraction of >50% (Simpson's method) to CRM, without ischemia, fibrosis area, or any other disease; (iii) age of 18 to 80 years, (iv) estimated glomerular filtration rate (eGFR) >60 mL/min/1.73 m 2 estimated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [9] (without microalbuminuria), and (vi) the capacity to read, understand, and sign the informed consent form and go to the clinical tests. The patients that presented any of the subsequent criteria were excluded: (i) pregnancy; (ii) valvular disease with significant ad...

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confidence: 69%

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

Kiuchi¹,

Chen²

2017

J Integr Cardiol

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“…We calculated the estimated glomerular filtration rate (eGFR) using the CKD-EPI equation, which is known to perform better for a larger range of GFR values [5]. The adopted protocol [6] for denervation involved the delivery of a higher number of ablative lesions per artery than in previous studies [7,8] and an irrigated catheter with the more wide contact area. Sympathetic activation is a trademark of the essential hypertensive state happening early in the clinical course of the disease, even in the controlled patients [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

The effects of renal sympathetic denervation in the left atrium enlargement after pulmonary vein isolation

Kiuchi¹,

Chen²,

Paz³

et al. 2017

J Integr Cardiol

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“…At the end of the procedure, the anatomy of the renal arteries was checked by angiography to assess whether there were any complications during the procedure. [18] The procedure was performed without any complications, and the patients remained clinically stable and awoke fully from sedation. Intravenous protamine was infused at the end of the procedure, and manual compression of the femoral artery was performed with a mean time of 15 min, followed by the compressive dressing.…”

Section: Renal Sympathetic Denervationmentioning

confidence: 95%

“…Some small focal irregularities of the renal arteries that were present during the procedure (possibly due to minor spasm or oedema) were no longer seen postoperatively. [18] At the sixth month after the procedure all the patients from RSD group underwent a Doppler scan of renal arteries without any evidence of stenosis or flow limitation. [18] Effects on blood pressure…”

Section: Safety Evaluation Of Rsdmentioning

confidence: 99%

Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

Kiuchi¹,

Chen

Silva³

et al. 2017

J.ATAMIS

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Aim: The aim of this prospective observational non-inferiority study was to compare the capacity for control of essential hypertension between renal sympathetic denervation (RSD) and either angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB).Methods and results: Seventy-four previously controlled essential hypertensive patients on ACEI/ARB monotherapy were evaluated; eleven patients agreed to proceed with RSD and had their antihypertensive agent withdrawn on the day of the procedure. During the six months of follow-up, there was no significant change in mean 24-hour ambulatory blood pressure measurements (ABPM) from baseline to three and sixmonths in the ACEI/ARB group (118±8/80±3 vs. 116±8/79±3 and 115±8/79±4 mmHg, respectively). No change was also observed in the RSD group (117±8/81±2 vs. 115±6/80±2 and 114±7/79±3 mmHg, respectively). There were no differences between groups at interval time points. There were also no changes in renal function or echocardiographic parameters, during follow-up.Conclusions: For the first time, this study reports possible non-inferiority of RSD when compared to ACEI or ARB monotherapy in the control of essential hypertension. A randomized trial with appropriate concealment of treatment, more patients and an extended follow-up period is needed to evaluate the potential benefits of RSD in comparison to ACEI/ARB use in patients with controlled hypertension.

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Effects of renal denervation with a standard irrigated cardiac ablation catheter on blood pressure and renal function in patients with chronic kidney disease and resistant hypertension

Abstract: The procedure using SICAC seemed to be feasible, effective, and safe resulting in a better control of BP, a short-term increase in estimated glomerular filtration rate, and reduced albuminuria. Although encouraging, our data are preliminary and need to be validated in the long term.

Cited by 80 publications

References 33 publications

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

Acute epinephrine test after renal sympathetic denervation in uncontrolled hypertensive patients

The effects of renal sympathetic denervation in the left atrium enlargement after pulmonary vein isolation

Pharmacological Monotherapy versus Renal Artery Denervation in Controlled Hypertensive Patients

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