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- Title
Proof of concept study: renal sympathetic denervation for treatment of polymorphic premature ventricular complexes.
- Authors
Kiuchi, Márcio; Silva, Gustavo; Paz, Luis; Chen, Shaojie; Souto, Gladyston; Kiuchi, Márcio Galindo; E Silva, Gustavo Ramalho; Paz, Luis Marcelo Rodrigues; Souto, Gladyston Luiz Lima
- Abstract
<bold>Background or Purpose: </bold>Polymorphic premature ventricular complexes (PVCs) are very common, appearing most frequently in patients with hypertension, obesity, sleep apnea, and structural heart disease. Sympathetic hyperactivity plays a critical role in the development, maintenance, and aggravation of ventricular arrhythmias. Recently, the relevance of sympathetic activation in patients with ventricular arrhythmias was reported, and this finding suggested a potential role for catheter-based renal sympathetic denervation in reducing the arrhythmic burden.<bold>Methods: </bold>We evaluated the effectiveness of the renal sympathetic denervation (RSD) in comparison to antiarrhythmic pharmacologic therapy in reducing polymorphic PVCs refractory to medication therapy and cardiac parameters assessed by 24-h Holter monitoring and cardiac magnetic resonance (CRM), respectively, in patients with structurally normal heart.<bold>Results: </bold>Thirty-four patients were included in this study, 14 served as control, and 20 were treated with an ablation cardiac catheter with open irrigated tip. RSD was performed by a single operator following the standard technique. All the patients included had polymorphic PVCs and structurally normal heart. Data were obtained at baseline at the 12th month of follow-up (sixth month after RSD or adjustment of antiarrhythmic dosage). In RSD group, we observed a significant decrease in the number of polymorphic PVCs from baseline 36,091 ± 3327 to 3, 6, 7 (first month after RSD, without drugs), and 12 months (sixth month after RSD, without drugs) of follow-up, 31,009 ± 3251, 20,411 ± 3820, 7701 ± 1549, and 1274 ± 749, respectively, in all patients, P < 0.0001 to all the comparisons between the mean of each time point with the mean of every other time point. No changes in mean 24-h ABPM and renal function in both groups were observed at 12th month of follow-up. However, 24-h Holter mean heart rate decreased in control group at 12th month of follow-up, which did not happen with the RSD group. At the sixth month post-RSD in comparison to baseline, a significant reduction in the number of polymorphic PVCs (∆ = -34,817 ± 3590, P < 0.0001) was observed, as well as, in CRM parameters such as left ventricular mass/body surface area (∆ = -5.4 ± 2.1 g/m2, P < 0.0001) and left ventricular ejection fraction (∆ = +3.0 ± 1.8 %, P < 0.0001). In comparison to control group at the same time point, these findings were statistically superior in RSD group (P > 0.05). A significant correlation was found between the Δ number of polymorphic PVCs at the sixth month (r = -0.6723, P = 0.0012) after the RSD and the total number of RSD ablated spots.<bold>Conclusions: </bold>Polymorphic PVCs refractory to medication therapy may be modifiable by RSD in patients without structural heart disease. Although encouraging, our data are preliminary and need to be validated in a large population and in long term.
- Subjects
VENTRICULAR arrhythmia; DENERVATION; CARDIAC magnetic resonance imaging; PATIENT monitoring; LEFT heart ventricle; ARRHYTHMIA diagnosis; ARRHYTHMIA treatment; KIDNEY innervation; KIDNEY surgery; MYOCARDIAL depressants; COMPARATIVE studies; RESEARCH methodology; MEDICAL cooperation; RESEARCH; SYMPATHECTOMY; PILOT projects; EVALUATION research; RANDOMIZED controlled trials; TREATMENT effectiveness; THERAPEUTICS
- Publication
Journal of Interventional Cardiac Electrophysiology, 2016, Vol 47, Issue 2, p221
- ISSN
1383-875X
- Publication type
journal article
- DOI
10.1007/s10840-016-0146-1