Renal nerve stimulation: complete versus incomplete renal sympathetic denervation

Hoogerwaard, Annemiek F.; Adiyaman, Ahmet; Jong, Mark R. de; Smit, Jjj; Heeg, Jan-Evert; Hasselt, Boudewijn A.A.M. van; Elvan, Arif

doi:10.1080/08037051.2021.1982376

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…(17%) patients with <0 mmHg residual RNS-induced BP response after RDN, at the site with the greatest systolic BP response before RDN, had a significantly lower mean 24-h systolic BP at follow-up (Table 2). 39 These studies supported the use of RNS as a peri-procedural tool to guide RDN and assess its immediate effect. A small RNS-induced systolic BP increase after RDN may be a good predictor of the BPlowering effect of RDN.…”

Section: Renal Nerve Stimulation Results From Human Studiesmentioning

confidence: 72%

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The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini‐review

Huang

Cheng

Chia

et al. 2022

J of Clinical Hypertension

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Recent trials have demonstrated the efficacy and safety of percutaneous renal sympathetic denervation (RDN) for blood pressure (BP)-lowering in patients with uncontrolled hypertension. Nevertheless, major challenges exist, such as the wide variation of BP-lowering responses following RDN (from strong response to no response) and lack of feasible and reproducible peri-procedural predictors for patient response. Both animal and human studies have demonstrated different patterns of BP responsesfollowing renal nerve stimulation (RNS), possibly related to varied regional proportions of sympathetic and parasympathetic nerve tissues along the renal arteries. Animal studies of RNS have shown that rapid electrical stimulation of the renal arteries causedThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Section: Renal Nerve Stimulation Results From Human Studiesmentioning

confidence: 72%

“…Among the 36 patients with available records of acute RNS‐induced BP changes, 6 (17%) patients with <0 mmHg residual RNS‐induced BP response after RDN, at the site with the greatest systolic BP response before RDN, had a significantly lower mean 24‐h systolic BP at follow‐up (Table 2 ). 39 …”

Section: Renal Nerve Stimulation Studiesmentioning

confidence: 99%

The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini‐review

Huang

Cheng

Chia

et al. 2022

J of Clinical Hypertension

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“…Since then, various randomized sham-controlled studies have demonstrated an overall benefit for renal nerve denervation as an antihypertensive treatment, though individual responses can still vary [ 305 – 307 ]. Recently, renal nerve stimulation has received increasing attention as a method of guiding adequate renal denervation [ 308 , 309 ]. Renal nerve stimulation prior to ablation can help localize renal plexus; a mitigated increase in blood pressure response to stimulation post-denervation has been reported to positively correlate with long-term benefit of renal denervation [ 308 , 309 ].…”

Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

“…Recently, renal nerve stimulation has received increasing attention as a method of guiding adequate renal denervation [ 308 , 309 ]. Renal nerve stimulation prior to ablation can help localize renal plexus; a mitigated increase in blood pressure response to stimulation post-denervation has been reported to positively correlate with long-term benefit of renal denervation [ 308 , 309 ].…”

Section: Clinical Parameters Of Autonomic Dysfunction and Evidence Fo...mentioning

confidence: 99%

Autonomic control of ventricular function in health and disease: current state of the art

2023

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Purpose Cardiac autonomic dysfunction is one of the main pillars of cardiovascular pathophysiology. The purpose of this review is to provide an overview of the current state of the art on the pathological remodeling that occurs within the autonomic nervous system with cardiac injury and available neuromodulatory therapies for autonomic dysfunction in heart failure. Methods Data from peer-reviewed publications on autonomic function in health and after cardiac injury are reviewed. The role of and evidence behind various neuromodulatory therapies both in preclinical investigation and in-use in clinical practice are summarized. Results A harmonic interplay between the heart and the autonomic nervous system exists at multiple levels of the neuraxis. This interplay becomes disrupted in the setting of cardiovascular disease, resulting in pathological changes at multiple levels, from subcellular cardiac signaling of neurotransmitters to extra-cardiac, extra-thoracic remodeling. The subsequent detrimental cycle of sympathovagal imbalance, characterized by sympathoexcitation and parasympathetic withdrawal, predisposes to ventricular arrhythmias, progression of heart failure, and cardiac mortality. Knowledge on the etiology and pathophysiology of this condition has increased exponentially over the past few decades, resulting in a number of different neuromodulatory approaches. However, significant knowledge gaps in both sympathetic and parasympathetic interactions and causal factors that mediate progressive sympathoexcitation and parasympathetic dysfunction remain. Conclusions Although our understanding of autonomic imbalance in cardiovascular diseases has significantly increased, specific, pivotal mediators of this imbalance and the recognition and implementation of available autonomic parameters and neuromodulatory therapies are still lagging.

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“…RNS may help to distinguish the complete denervation, and changes in BP after RNS may serve as an effective ablation endpoint ( 20 ). Hoogerwaard et al ( 21 ) reported that, after 10-month follow-up, patients without residual RNS-induced BP response had a significant lower 24-h systolic BP compared to the patients with residual RNS-induced BP response (126 ± 4 vs. 135 ± 10 mmHg, p = 0.04). This finding may conduce to solve the issue of “blind RDN,” and patients who still respond to RNS after RDN may be advised to receive the second RDN.…”

Section: Renal Denervationmentioning

confidence: 99%

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

Xiong

et al. 2021

Front. Cardiovasc. Med.

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Sympathetic overactivation plays an important role in promoting a variety of pathophysiological processes in cardiovascular diseases (CVDs), including ventricular remodeling, vascular endothelial injury and atherosclerotic plaque progression. Device-based sympathetic nerve (SN) regulation offers a new therapeutic option for some CVDs. Renal denervation (RDN) is the most well-documented method of device-based SN regulation in clinical studies, and several large-scale randomized controlled trials have confirmed its value in patients with resistant hypertension, and some studies have also found RDN to be effective in the control of heart failure and arrhythmias. Pulmonary artery denervation (PADN) has been clinically shown to be effective in controlling pulmonary hypertension. Hepatic artery denervation (HADN) and splenic artery denervation (SADN) are relatively novel approaches that hold promise for a role in cardiovascular metabolic and inflammatory-immune related diseases, and their first-in-man studies are ongoing. In addition, baroreflex activation, spinal cord stimulation and other device-based therapies also show favorable outcomes. This review summarizes the pathophysiological rationale and the latest clinical evidence for device-based therapies for some CVDs.

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Renal nerve stimulation: complete versus incomplete renal sympathetic denervation

Cited by 6 publications

References 27 publications

The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini‐review

The role of renal nerve stimulation in percutaneous renal denervation for hypertension: A mini‐review

Autonomic control of ventricular function in health and disease: current state of the art

Device-Based Sympathetic Nerve Regulation for Cardiovascular Diseases

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