Luciana V Armaganijan1, Rodolfo Staico2, Dalmo A R Moreira2, Renato D Lopes3, Paulo T J Medeiros2, Ricardo Habib2, Jônatas Melo Neto2, Marcelo Katz4, Dikran Armaganijan2, Amanda G M R Sousa2, Felix Mahfoud5, Alexandre Abizaid2. 1. Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. Electronic address: luciana_va@hotmail.com. 2. Dante Pazzanese Institute of Cardiology, São Paulo, Brazil. 3. Duke Clinical Research Institute, Durham, North Carolina; Brazilian Clinical Research Institute, São Paulo, Brazil. 4. Brazilian Clinical Research Institute, São Paulo, Brazil. 5. Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistiche Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Harvard-MIT Biomedical Engineering, Institute of Medical Engineering and Science, Cambridge, Massachusetts.
Abstract
OBJECTIVES: This study aimed to assess 6-month outcomes in patients with implantable cardioverter-defibrillators (ICDs) undergoing renal sympathetic denervation (RSD) for refractory ventricular arrhythmias (VAs). BACKGROUND: ICDs are generally indicated for patients at high risk of malignant VAs. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of VAs. METHODS: A total of 10 patients with refractory VA underwent RSD. Underlying conditions were Chagas disease (n = 6), nonischemic dilated cardiomyopathy (n = 2), and ischemic cardiomyopathy (n = 2). Information on the number of ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes and device therapies (antitachycardia pacing/shocks) in the previous 6 months as well as 1 and 6 months post-treatment was obtained from ICD interrogation. RESULTS: The median number of VT/VF episodes/antitachycardia pacing/shocks 6 months before RSD was 28.5 (range 1 to 106)/20.5 (range 0 to 52)/8 (range 0 to 88), respectively, and was reduced to 1 (range 0 to 17)/0 (range 0 to 7)/0 (range 0 to 3) at 1 month and 0 (range 0 to 9)/0 (range 0 to 7)/0 (range 0 to 3) at 6 months afterward, respectively. There were no major procedure-related complications. Two patients experienced sustained VT within the first week; in both cases, no further episodes occurred during follow-up. Two patients were nonresponders: 1 with persistent idioventricular rhythm and 1 with multiple renal arteries and incomplete ablation. Three patients died during follow-up. None of the deaths was attributed to VA. CONCLUSIONS: In patients with ICDs and refractory VAs, RSD was associated with reduced arrhythmic burden with no procedure-related complications. Randomized controlled trials investigating RSD for treatment of refractory VAs in patients with increased sympathetic activity are needed.
OBJECTIVES: This study aimed to assess 6-month outcomes in patients with implantable cardioverter-defibrillators (ICDs) undergoing renal sympathetic denervation (RSD) for refractory ventricular arrhythmias (VAs). BACKGROUND: ICDs are generally indicated for patients at high risk of malignant VAs. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of VAs. METHODS: A total of 10 patients with refractory VA underwent RSD. Underlying conditions were Chagas disease (n = 6), nonischemic dilated cardiomyopathy (n = 2), and ischemic cardiomyopathy (n = 2). Information on the number of ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes and device therapies (antitachycardia pacing/shocks) in the previous 6 months as well as 1 and 6 months post-treatment was obtained from ICD interrogation. RESULTS: The median number of VT/VF episodes/antitachycardia pacing/shocks 6 months before RSD was 28.5 (range 1 to 106)/20.5 (range 0 to 52)/8 (range 0 to 88), respectively, and was reduced to 1 (range 0 to 17)/0 (range 0 to 7)/0 (range 0 to 3) at 1 month and 0 (range 0 to 9)/0 (range 0 to 7)/0 (range 0 to 3) at 6 months afterward, respectively. There were no major procedure-related complications. Two patients experienced sustained VT within the first week; in both cases, no further episodes occurred during follow-up. Two patients were nonresponders: 1 with persistent idioventricular rhythm and 1 with multiple renal arteries and incomplete ablation. Three patients died during follow-up. None of the deaths was attributed to VA. CONCLUSIONS: In patients with ICDs and refractory VAs, RSD was associated with reduced arrhythmic burden with no procedure-related complications. Randomized controlled trials investigating RSD for treatment of refractory VAs in patients with increased sympathetic activity are needed.
Authors: Dominik Linz; Mathias Hohl; Adrian D Elliott; Dennis H Lau; Felix Mahfoud; Murray D Esler; Prashanthan Sanders; Michael Böhm Journal: Clin Auton Res Date: 2018-02-10 Impact factor: 4.435
Authors: Christian Ukena; Felix Mahfoud; Sebastian Ewen; Andreas Bollmann; Gerhard Hindricks; Boris A Hoffmann; Dominik Linz; Dan Musat; Valerie Pavlicek; Eberhard Scholz; Dierk Thomas; Stephan Willems; Michael Böhm; Jonathan S Steinberg Journal: Clin Res Cardiol Date: 2016-06-30 Impact factor: 5.460