Marat Fudim1,2, Asher A Sobotka3, Yue-Hui Yin4, Joanne W Wang5, Howard Levin6, Murray Esler7, Jie Wang8,9, Paul A Sobotka10. 1. Duke University Medical Center, Durham, NC, USA. 2. Duke Clinical Research Institute, Durham, NC, USA. 3. St. Paul Academy and Summit School, St. Paul, MN, USA. 4. The 2nd Affiliated Hospital of Chongqing Medical University, Chongqin, China. 5. Horace Mann, Bronx, NY, USA. 6. Coridea, New York, NY, USA. 7. Baker Heart and Diabetes Institute, Melbourne, Australia. 8. Columbia University, New York, NY, USA. 9. SyMap Medical Ltd., Suzhou, China. 10. Rox Medical, Inc., San Clemente, CA, USA. sobotka@alumni.stanford.edu.
Abstract
PURPOSE OF REVIEW: Review the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN. RECENT FINDINGS: Recent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effects of unselective global RDN. Subsequent studies have suggested the presence of a heterogeneous fiber population and the potential utility of renal nerve stimulation to identify sympatho-stimulatory fibers or "hot spots." The recognition that RDN can produce heterogeneous afferent sympathetic effects both change therapeutic goals and revitalize the potential of therapeutic RDN to provide significant clinical benefits. Renal nerve stimulation has emerged as potential tool to identify sympatho-stimulatory fibers, avoid sympatho-inhibitory fibers, and thus guide selective RDN.
PURPOSE OF REVIEW: Review the renal nerve anatomy and physiology basics and explore the concept of global vs. selective renal denervation (RDN) to uncover some of the fundamental limitations of non-targeted renal nerve ablation and the potential superiority of selective RDN. RECENT FINDINGS: Recent trials testing the efficacy of RDN showed mixed results. Initial investigations targeted global RDN as a therapeutic goal. The repeat observation of heterogeneous response to RDN including non-responders with lack of a BP reduction, or even more unsettling, BP elevations after RDN has raised concern for the detrimental effects of unselective global RDN. Subsequent studies have suggested the presence of a heterogeneous fiber population and the potential utility of renal nerve stimulation to identify sympatho-stimulatory fibers or "hot spots." The recognition that RDN can produce heterogeneous afferent sympathetic effects both change therapeutic goals and revitalize the potential of therapeutic RDN to provide significant clinical benefits. Renal nerve stimulation has emerged as potential tool to identify sympatho-stimulatory fibers, avoid sympatho-inhibitory fibers, and thus guide selective RDN.
Entities:
Keywords:
Hot spots; Hypertension; Nerve stimulation; Renal denervation; Renal nerves
Authors: Dagmara Hering; Felix Mahfoud; Antony S Walton; Henry Krum; Gavin W Lambert; Elisabeth A Lambert; Paul A Sobotka; Michael Böhm; Bodo Cremers; Murray D Esler; Markus P Schlaich Journal: J Am Soc Nephrol Date: 2012-05-17 Impact factor: 10.121
Authors: Ulla C Kopp; Michael Z Cicha; Lori A Smith; Jan Mulder; Tomas Hökfelt Journal: Am J Physiol Regul Integr Comp Physiol Date: 2007-08-15 Impact factor: 3.619
Authors: Alissa A Frame; Casey Y Carmichael; Jill T Kuwabara; J Thomas Cunningham; Richard D Wainford Journal: Exp Physiol Date: 2019-05-27 Impact factor: 2.969
Authors: Melvin D Lobo; Andrew S P Sharp; Vikas Kapil; Justin Davies; Mark A de Belder; Trevor Cleveland; Clare Bent; Neil Chapman; Indranil Dasgupta; Terry Levy; Anthony Mathur; Matthew Matson; Manish Saxena; Francesco P Cappuccio Journal: Heart Date: 2019-07-10 Impact factor: 5.994
Authors: Ana Jorbenadze; Marat Fudim; Felix Mahfoud; Phillip B Adamson; Tarek Bekfani; Rolf Wachter; Horst Sievert; Piotr P Ponikowski; John G F Cleland; Stefan D Anker Journal: ESC Heart Fail Date: 2021-05-18