Renal Denervation Reduced Ventricular Arrhythmia After Myocardial Infarction by Inhibiting Sympathetic Activity and Remodeling

Abstract

Background Ventricular arrhythmia after myocardial infarction is the most important risk factor for sudden cardiac death, which poses a serious threat to human health. As the correlation between autonomic nervous systemic dysfunction and heart rhythm abnormality has been gradually revealed, remedies targeting autonomic nervous system dysfunction, especially the sympathetic nerve, have emerged. Among them, renal denervation is noted for its powerful effect on the inhibition of sympathetic nerve activity. We aim to investigate whether renal denervation can reduce ventricular arrhythmia after myocardial infarction and thus decrease the risk of sudden cardiac death. In addition, we explore the potential mechanism with respect to nerve activity and remodeling. Methods and Results Twenty‐four beagles were randomized into the control (n=4), renal denervation (n=10), and sham (n=10) groups. Permanent left anterior descending artery ligation was performed to establish myocardial infarction in the latter 2 groups. Animals in the renal denervation group underwent both surgical and chemical renal denervation. Compared with dogs in the sham group, dogs in the renal denervation group demonstrated attenuated effective refractory period shortening and inhomogeneity, flattened restitution curve, increased ventricular threshold, and decreased ventricular arrhythmia. Heart rate variability assessment, catecholamine measurement, and nerve discharge recordings all indicated that renal denervation could reduce whole‐body and local tissue sympathetic tone. Tissue analysis revealed a significant decrease in neural remodeling in both the heart and stellate ganglion. Conclusions Surgical and chemical renal denervation decreased whole‐body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion. Consequently, renal denervation led to beneficial remodeling of the electrophysiological characteristics in the infarction border zone, translating to a decrease in ventricular arrhythmia after myocardial infarction.

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

“…RSD decreases spontaneous VAs in porcine models of ischemia rates of spontaneous VAs in porcine models of ischemia . In a canine study of myocardial ischemia, RSD led to decreased whole‐body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion . This resulted in beneficial electrophysiological changes in border zones of infarcts, culminating in decreased VAs .…”

“…[94][95][96] In a canine study of myocardial ischemia, RSD led to decreased whole-body and local tissue sympathetic activity and reversed neural remodeling in the heart and stellate ganglion. 97 This resulted in beneficial electrophysiological changes in border zones of infarcts, culminating in decreased VAs. 97 There have also been a few small studies in patients with refractory VAs or VT storm that showed a reduction in VAs after RSD.…”

“…97 This resulted in beneficial electrophysiological changes in border zones of infarcts, culminating in decreased VAs. 97 There have also been a few small studies in patients with refractory VAs or VT storm that showed a reduction in VAs after RSD. 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.…”

Neuromodulation Therapy in Heart Failure: Combined Use of Drugs and Devices

“…55 In addition, the utility of RND in both atrial and ventricular arrhythmias. [56][57][58][59] The utility of RDN in HF patients was first reported in the Rehabilitation Enhancing Aging Through Connected Health (REACH) Pilot study. 60 Patients with chronic symptomatic HF on optimal medical therapy underwent RDN.…”

Effect of Renal Denervation on Cardiac Function and Inflammatory Factors in Heart Failure After Myocardial Infarction

“… 15 The beneficial effect of RDN has been demonstrated in HF. 16 , 17 However, the underlying mechanism is unclear.…”