Renal denervation as adjunctive therapy to cardiac sympathetic denervation for ablation refractory ventricular tachycardia

Bradfield, Jason S.; Hayase, Justin; Liu, Kevin; Moriarty, John M.; Kee, Stephen T.; Do, Duc; Ajijola, Olujimi A.; Vaseghi, Marmar; Gima, Jean; Sorg, Julie M.; Cote, Shelly; Pavez, Geraldine; Buch, Éric; Khakpour, Houman; Krokhaleva, Yuliya; Macias, Carlos; Fujimura, Osamu; Boyle, Noel G.; Shivkumar, Kalyanam

doi:10.1016/j.hrthm.2019.09.016

Cited by 41 publications

(19 citation statements)

References 17 publications

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“…Whether further sympathetic modulation can provide benefit in these patients is not known. Renal denervation is another promising therapy for autonomic modulation in the treatment of ventricular arrhythmias, with a recent case series demonstrating benefit 16 . However, this requires further study before broader application.…”

Section: Discussionmentioning

confidence: 99%

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes

Hayase

Dusi

et al. 2020

Cardiovasc electrophysiol

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Introduction Cardiac sympathetic denervation (CSD) is utilized for the management of ventricular tachycardia (VT) in structural heart disease when refractory to radiofrequency ablation (RFA) or when patient/VT characteristics are not conducive to RFA. Methods We studied consecutive patients who underwent CSD at our institution from 2009 to 2018 with VT requiring repeat RFA post‐CSD. Patient demographics, VT/procedural characteristics, and outcomes were assessed. Results Ninety‐six patients had CSD, 16 patients underwent RFA for VT post‐CSD. There were 15 male and 1 female patients with mean age of 54.2 ± 13.2 years. Fourteen patients had nonischemic cardiomyopathy. A mean of 2.0 ± 0.8 RFAs for VT was unsuccessful before the patient undergoing CSD. The median time between CSD and RFA was 104 days (interquartile range [IQR] = 15–241). The clinical VT cycle length was significantly increased after CSD both spontaneously on ECG and/or ICD interrogation (355 ± 73 ms pre‐CSD vs. 422 ± 94 ms post‐CSD, p = .001) and intraprocedurally (406 ± 86 ms pre‐CSD vs. 457 ± 88 ms post‐CSD, p = .03). Two patients had polymorphic and 14 had monomorphic VT (MMVT) pre‐CSD, and all patients had MMVT post‐CSD. The proportion of mappable, hemodynamically stable VTs increased from 35% during pre‐CSD RFA to 58% during post‐CSD RFA (p = .038). At median follow‐up of 413 days (IQR = 43–1840) after RFA, eight patients had no further VT. Conclusion RFA for recurrent MMVT post‐CSD is a reasonable treatment option with intermediate‐term clinical success in 50% of patients. Clinical VT cycle length was significantly increased after CSD with associated improvement in mappable, hemodynamically tolerated VT during RFA.

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Section: Discussionmentioning

confidence: 99%

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes

Hayase

Dusi

et al. 2020

Cardiovasc electrophysiol

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“…One study analyzed the effect of RDN in combination of cardiac sympathetic denervation and it was excluded from the analysis. 10 The PRISMA flow diagram for the selection of studies is presented in Figure 1.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Renal denervation for the treatment of ventricular arrhythmias: A systematic review and meta‐analysis

Prado

Mahfoud

Lópes

et al. 2021

Cardiovasc electrophysiol

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Introduction: Ventricular arrhythmias (VAs) are a major cause of morbidity and mortality in patients with heart disease. Recent studies evaluated the effect of renal denervation (RDN) on the occurrence of VAs. We conducted a systematic review and metaanalysis to determine the efficacy and safety of this procedure.Methods and Results: A systematic search of the literature was performed to identify studies that evaluated the use of RDN for the management of VAs. Primary outcomes were reduction in the number of VAs and implantable cardioverter-defibrillator (ICD) therapies. Secondary outcomes were changes in blood pressure and renal function. Ten studies (152 patients) were included in the meta-analysis. RDN was associated with a reduction in the number of VAs, antitachycardia pacing, ICD shocks, and overall ICD therapies of 3.53 events/patient/month (95% confidence interval [CI] = −5.48 to −1.57), 2.86 events/patient/month (95% CI = −4.09 to −1.63), 2.04 events/patient/month (95% CI = −2.12 to −1.97), and 2.68 events/patient/month (95% CI = −3.58 to −1.78), respectively. Periprocedural adverse events occurred in 1.23% of patients and no significant changes were seen in blood pressure or renal function. Conclusions:In patients with refractory VAs, RDN was associated with a reduction in the number of VAs and ICD therapies, and was shown to be a safe procedure.

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“…A study of 32 patients with refractory VAs found a significant reduction in VA burden, ICD shocks, and anti‐tachycardia pacing (ATP) therapy with catheter ablation combined with adjunctive RSD when compared to catheter ablation alone, without significant differences in mortality between the two groups . In another study of 10 patients with cardiomyopathy who underwent RSD as an adjunctive therapy to CSD for refractory VT, ICD therapies were significantly reduced . However, careful mechanistic studies are still needed to define the role of RSD before large randomized clinical trials can be safety initiated to investigate long‐term efficacy and safety profile for this intervention.…”

Section: Effects Of Neuromodulation On Ventricular Arrhythmiasmentioning

confidence: 99%

“…98 In another study of 10 patients with cardiomyopathy who underwent RSD as an adjunctive therapy to CSD for refractory VT, ICD therapies were significantly reduced. 99 However, careful mechanistic studies are still needed to define the role of RSD before large randomized clinical trials can be safety initiated to investigate long-term efficacy and safety profile for this intervention.…”

Section: Blockade Of Sympathetic Neurotransmissionmentioning

confidence: 99%

The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure

Wu¹,

Vaseghi²

2020

Pacing Clinical Electrophis

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Ventricular arrhythmias (VA) can range in presentation from asymptomatic to cardiac arrest and sudden cardiac death (SCD). Sustained ventricular tachycardias/ventricular fibrillation (VT/VF) are a common cause of SCD in the setting of myocardial infarction (MI) and heart failure. A particularly arrhythmogenic cardiac syncytia in these conditions can be attributed to both sympathetic activation and parasympathetic dysfunction, while appropriate neuromodulation has the potential to reduce occurrence of VT/VF. In this review, we outline the components of the autonomic nervous system that play an important role in normal cardiac electrophysiology and function. In addition, we discuss changes that occur in the setting of cardiac disease including adverse neural remodeling and neurohormonal activation which significantly contribute to propensity for VT/VF. Finally, we review neuromodulation strategies to mitigate VT/VF which predominantly rely on increasing parasympathetic drive and blockade of sympathetic neurotransmission.

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Renal denervation as adjunctive therapy to cardiac sympathetic denervation for ablation refractory ventricular tachycardia

Cited by 41 publications

References 17 publications

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes

Recurrent ventricular tachycardia after cardiac sympathetic denervation: Prolonged cycle length with improved hemodynamic tolerance and ablation outcomes

Renal denervation for the treatment of ventricular arrhythmias: A systematic review and meta‐analysis

The autonomic nervous system and ventricular arrhythmias in myocardial infarction and heart failure

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