Pierre C Qian1, Michael A Barry2, Juntang Lu3, Jim Pouliopoulos4, Ashraf Mina5, Sushil Bandodkar6, Shirley Alvarez6, Virginia James7, John Ronquillo8, Winny Varikatt8, Aravinda Thiagalingam9, Stuart P Thomas9. 1. Cardiology Department, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; The Westmead Institute for Medical Research, Sydney, Australia. Electronic address: pierre.qian@sydney.edu.au. 2. Cardiology Department, Westmead Hospital, Sydney, Australia; School of Electrical and Information Engineering, University of Sydney, Sydney, Australia. 3. Cardiology Department, Westmead Hospital, Sydney, Australia. 4. Cardiology Department, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia. 5. NSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia. 6. Biochemistry Department, The Children's Hospital at Westmead, Sydney, Australia. 7. The Westmead Institute for Medical Research, Sydney, Australia. 8. Department of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia. 9. Cardiology Department, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; The Westmead Institute for Medical Research, Sydney, Australia.
Abstract
OBJECTIVES: This study sought to develop a method to assess renal sympathetic nerve function through localization and pacing of aorticorenal ganglia (ARG). BACKGROUND: Transcatheter renal denervation procedures often fail to produce complete renal denervation because of the lack of a physiological procedural endpoint. METHODS: High-frequency pacing was performed in the inferior vena cava and aorta in sheep (n = 19) to identify ARG pace-capture sites. Group A (n = 5) underwent injection at the ARG pace-capture site for histological verification, group B (n = 6) underwent unilateral irrigated radiofrequency ablation of ARG pace-capture sites and assessment of renal innervation at 1 week post-procedure; and group C (n = 8) underwent ARG pacing before and 2 to 3 weeks after unilateral microwave renal denervation. RESULTS: ARG pace-capture responses were observed at paired discrete sites above the ipsilateral renal artery eliciting a change in mean arterial blood pressure of 22.2 (interquartile range [IQR]: 15.5 to 34.3 mm Hg; p < 0.001) with concurrent ipsilateral renal arterial vasoconstriction, change in main renal artery diameter of -0.42 mm (IQR: -0.64 to -0.24 mm; p < 0.0001), and without consistent contralateral renal vasoconstriction. Sympathetic ganglionic tissue was observed at ARG pace-capture sites, and ganglion ablation led to significant ipsilateral renal denervation. Circumferential renal denervation resulted in immediate and sustained abolition of ARP pacing-induced renal vasoconstriction and significant ipsilateral renal denervation. CONCLUSIONS: Transvascular ARG pace-capture is feasible and recognized by concurrent hypertensive and ipsilateral renal arterial vasoconstrictive responses. Abolition of ARG pacing-induced vasoconstriction may indicate successful renal sympathetic denervation and serve as a physiological procedural endpoint to guide transcatheter renal denervation.
OBJECTIVES: This study sought to develop a method to assess renal sympathetic nerve function through localization and pacing of aorticorenal ganglia (ARG). BACKGROUND: Transcatheter renal denervation procedures often fail to produce complete renal denervation because of the lack of a physiological procedural endpoint. METHODS: High-frequency pacing was performed in the inferior vena cava and aorta in sheep (n = 19) to identify ARG pace-capture sites. Group A (n = 5) underwent injection at the ARG pace-capture site for histological verification, group B (n = 6) underwent unilateral irrigated radiofrequency ablation of ARG pace-capture sites and assessment of renal innervation at 1 week post-procedure; and group C (n = 8) underwent ARG pacing before and 2 to 3 weeks after unilateral microwave renal denervation. RESULTS:ARG pace-capture responses were observed at paired discrete sites above the ipsilateral renal artery eliciting a change in mean arterial blood pressure of 22.2 (interquartile range [IQR]: 15.5 to 34.3 mm Hg; p < 0.001) with concurrent ipsilateral renal arterial vasoconstriction, change in main renal artery diameter of -0.42 mm (IQR: -0.64 to -0.24 mm; p < 0.0001), and without consistent contralateral renal vasoconstriction. Sympathetic ganglionic tissue was observed at ARG pace-capture sites, and ganglion ablation led to significant ipsilateral renal denervation. Circumferential renal denervation resulted in immediate and sustained abolition of ARP pacing-induced renal vasoconstriction and significant ipsilateral renal denervation. CONCLUSIONS: Transvascular ARG pace-capture is feasible and recognized by concurrent hypertensive and ipsilateral renal arterial vasoconstrictive responses. Abolition of ARG pacing-induced vasoconstriction may indicate successful renal sympathetic denervation and serve as a physiological procedural endpoint to guide transcatheter renal denervation.
Authors: V J M Zeijen; A A Kroon; B H van den Born; P J Blankestijn; S C A Meijvis; A Nap; E Lipsic; A Elvan; J Versmissen; R J van Geuns; M Voskuil; P A L Tonino; W Spiering; J Deinum; J Daemen Journal: Neth Heart J Date: 2022-08-24 Impact factor: 2.854