Vol. 19 No. 4 (2015)
HEART RHYTHM DISORDERS

Renal denervation to improve catheter ablation outcomes in patients with arterial hypertension and atrial fibrillation

PDF (Русский)
  • D. Zamanov,
  • A. Dmitriev,
  • S. Antonov,
  • L. Pristromova,
  • E. Ivanitskaya,
  • A. Pustovoitov,
  • E. Korchagin,
  • S. Artemenko,
  • V. Shabanov,
  • A. Romanov,
  • E. Pokushalov
D. Zamanov
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
A. Dmitriev
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
S. Antonov
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
L. Pristromova
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
E. Ivanitskaya
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
A. Pustovoitov
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
E. Korchagin
Regional Clinical Hospital, 3a Partizan Zhelezniak Street, 660022 Krasnoyarsk, Russian Federation
S. Artemenko
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
V. Shabanov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
A. Romanov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
E. Pokushalov
Academician Ye. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health Care of Russian Federation, 15 Rechkunovskaya St., 630055 Novosibirsk, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2015-4-119-129

Published 2016-01-11

Keywords

  • atrial fibrillation,
  • ablation,
  • renal denervation,
  • resistant hypertension,
  • moderate resistant hypertension

How to Cite

Zamanov, D., Dmitriev, A., Antonov, S., Pristromova, L., Ivanitskaya, E., Pustovoitov, A., Korchagin, E., Artemenko, S., Shabanov, V., Romanov, A., & Pokushalov, E. (2016). Renal denervation to improve catheter ablation outcomes in patients with arterial hypertension and atrial fibrillation. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 19(4), 119–129. https://doi.org/10.21688/1681-3472-2015-4-119-129

Copyright (c) 2016 Zamanov D.A., Dmitriev A.Yu., Antonov S.I., Pristromova L.V., Ivanitskaya E.E., Pustovoitov A.V., Korchagin E.E., Artemenko S.N., Shabanov V.V., Romanov A.B., Pokushalov E.A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Objective. The aim of this study was to assess the impact of RD in conjunction with pulmonary vein isolation (PVI) on patients with atrial fibrillation (AF) and moderate resistant or severe resistant hypertension.
Methods. The data for this study were obtained from two different prospective randomized trials and evaluated by means of meta-analysis. Patients with paroxysmal or persistent AF and moderate resistant hypertension (BP ≥140/90 mm Hg and <160/100 mm Hg; n = 60) or resistant hypertension (≥160/100 mm Hg; second study; n = 50) were randomized to PVI or PVI with RD groups and followed up during 18 months.
Results. Each group had 55 patients. At 18-months, 35 (63.6%) of the 55 PVI with RD group patients were AF-free vs 22 (40%) of the 55 patients in the PVI-only group (p = 0.013; log-rank test). In patients with severe hypertension, 16 (64%) of the 25 PVI with RD group patients vs 6 (24%) of the 25 PVI-only group patients were AF-free (p = 0.004; log-rank test). For moderate hypertension, the differences were less dramatic: 16 (53.3%) of 30 vs 19 (63.3%) of 30 when RD was added (p = 0.43). Superior efficacy of adding RD was most apparent in persistent AF and resistant hypertension (probability risk 0.24 95%, confidence interval 0.08–0.69, p = 0.012).
Conclusion. RD improves the outcomes of PVI, especially in patients with persistent AF and resistant hypertension.

PDF (Русский)

References

  1. Schlaich M.P., Schmieder R.E., Bakris G., Schmieder R.E., Bakris G., Blankestijn P.J., Böhm M., Campese V.M., Francis D.P., Grassi G., Hering D., Katholi R., Kjeldsen S., Krum H., Mahfoud F., Mancia G., Messerli F.H., Narkiewicz K., Parati G., Rocha-Singh K.J., Ruilope L.M., Rump L.C., Sica D.A., Sobotka P.A., Tsioufis C., Vonend O., Weber M.A., Williams B., Zeller T. International expert consensus statement: Percutaneous transluminal renal denervation for the treatment of resistant hypertension // J. Am. Coll. Cardiol. 2013. Vol. 62. № 22. P. 2031–45.
  2. Pokushalov E., Romanov A., Corbucci G., Artyomenko S., Baranova V., Turov A., Shirokova N., Karaskov A., Mittal S., Steinberg J.S. A randomized comparison of pulmonary vein isolation with versus without concomitant renal artery denervation in patients with refractory symptomatic atrial fibrillation and resistant hypertension // J. Am. Coll. Cardiol. 2012. Vol. 60. P. 1163–1170.
  3. Ukena C., Bauer A., Mahfoud F., Schreieck J., Neuberger H.R., Eick C., Sobotka P.A., Gawaz M., Bohm M. Renal sympathetic denervation for treatment of electrical storm: first-in-man experience // Clin. Res. Cardiol. 2012. Vol. 101. P. 63–67.
  4. Huxley R.R., Lopez F.L., Folsom A.R., Agarwal S.K., Loehr L.R., Soliman E.Z., Maclehose R., Konety S., Alonso A. Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: The Atherosclerosis Risk in Communities (ARIC) study // Circulation. 2011. Vol. 123. P. 1501–8.
  5. Fuster V., Ryden L.E., Cannom D.S., Crijns H.J., Curtis A.B., Ellenbogen K.A., Halperin J.L., Kay G.N., Le Huezey J.Y., Lowe J.E., Olsson S.B., Prystowsky E.N., Tamargo J.L., Wann L.S. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the american college of cardiology foundation/american heart association task force on practice guidelines // Circulation. 2011. Vol. 12. P. e269–367.
  6. Katritsis D.G., Toumpoulis I.K., Giazitzoglou E., Korovesis S., Karabinos I., Paxinos G., Zambartas C., Anagnostopoulos C.E. Latent arterial hypertension in apparently lone atrial fibrillation // J. Interv. Card. Electrophysiol. 2005. Vol. 13. P. 203–7.
  7. Schotten U., Verheule S., Kirchhof P., Goette A. Pathophysiological mechanisms of atrial fibrillation: A translational appraisal // Physiol. Rev. 2011. Vol. 91. P. 265–325.
  8. Lau D., Mackenzie L., Kelly D., Kelly D.J., Psaltis P.J., Brooks A.G., Worthington M., Rajendram A., Kelly D.R., Zhang Y., Kuklik P., Nelson A.J., Wong C.X., Worthley S.G., Rao M., Faull R.J., Edwards J., Saint D.A., Sanders P. Hypertension and atrial fibrillation: Evidence of progressive atrial remodeling with electrostructural correlate in a conscious chronically instrumented ovine model // Heart Rhythm. 2010. Vol. 7. P. 1282–1290.
  9. Bettoni M., Zimmermann M. Autonomic tone variations before the onset of paroxysmal atrial fibrillation // Circulation. 2002. Vol. 105. P. 2753–9.
  10. Arimoto T., Tada H., Igarashi M., Sekiguchi Y., Sato A., Koyama T., Yamasaki H., Machino T., Kuroki K., Kuga K., Aonuma K. High washout rate of iodine-123-metaiodobenzylguanidine imaging predicts the outcome of catheter ablation of atrial fibrillation // J. Cardiovasc. Electrophysiol. 2011. Vol. 22. P. 1297–1304.
  11. Katritsis D.G., Pokushalov E., Romanov A., Giazitzoglou E., Siontis G.C., Po S.S., Camm A.J., Ioannidis J.P. Autonomic Denervation Added to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: A Randomized Clinical Trial // J. Am. Coll. Cardiol. 2013. Vol. 62. № 24. P. 2318–25.
  12. Pokushalov E. The role of autonomic denervation during catheter ablation of atrial fibrillation // Curr. Opin. Cardiol. 2008. Vol. 23. № 1. P. 55–9.
  13. Chobanian A.V., Bakris G.L., Black H.R. Cushman W.C., Green L.A., Izzo J.L. Jr., Jones D.W., Materson B.J., Oparil S., Wright J.T. Jr., Roccella E.J. et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report // JAMA. 2003. Vol. 289. P. 2560–72.
  14. Mancia G., De Backer G., Dominiczak A., Cifkova R., Fagard R., Germano G., Grassi G., Heagerty A.M., Kjeldsen S.E., Laurent S., Narkiewicz K., Ruilope L., Rynkiewicz A., Schmieder R.E., Struijker Boudier H.A., Zanchetti A.; European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) // J. Hypertens. 2007. Vol. 25. P. 1105–87.
  15. Mancia G., Laurent S., Agabiti-Rosei E., Ambrosioni E., Burnier M., Caulfield M.J., Cifkova R., Clément D., Coca A., Dominiczak A., Erdine S., Fagard R., Farsang C., Grassi G., Haller H., Heagerty A., Kjeldsen S.E., Kiowski W., Mallion J.M., Manolis A., Narkiewicz K., Nilsson P., Olsen M.H., Rahn K.H., Redon J., Rodicio J., Ruilope L., Schmieder R.E., Struijker-Boudier H.A., van Zwieten P.A., Viigimaa M., Zanchetti A.; European Society of Hypertension Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document // J. Hypertens. 2009. Vol. 27. P. 2121–58.
  16. Ott C., Mahfoud F., Schmid A., Ditting T., Sobotka P.A., Veelken R., Spies A., Ukena C., Laufs U., Uder M., Böhm M., Schmieder R.E. Renal Denervation in Moderate Treatment-Resistant Hypertension // J. Am. Coll. Cardiol. 2013. Vol. 62. № 20. P. 1880–6.
  17. Krum H., Schlaich M., Whitbourn R., Sobotka P.A., Sadowski J., Bartus K., Kapelak B., Walton A., Sievert H., Thambar S., Abraham W.T., Esler M. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study // Lancet. 2009. Vol. 373. P. 1275–81.
  18. Заманов Д.А., Дмитриев А.Ю., Шильников Н.В., Иваницкая Э.Э., Романов А.Б., Покушалов Е.А. Модуляция автономной нервной системы с помощью денервации почечных артерий для лечения фибрилляции предсердий // Патология кровообращения и кардиохирургия. 2014. № 4. С. 113–122.
  19. Bhatt D.L., Kandzari D.E., O'Neill W.W., D'Agostino R., Flack J.M., Katzen B.T., Leon M.B., Liu M., Mauri L., Negoita M., Cohen S.A., Oparil S., Rocha-Singh K., Townsend R.R., Bakris G.L.; SYMPLICITY HTN-3 Investigators. A controlled trial of renal denervation for resistant hypertension // N. Engl. J. Med. 2014. Vol. 370. № 15. P. 1393–401.
  20. Joshi S., Choi A.D., Kamath G.S., Raiszadeh F., Marrero D., Badheka A., Mittal S., Steinberg J.S. Prevalence, predictors, and prognosis of atrial fibrillation early after pulmonary vein isolation: Findings from 3 months of continuous automatic ECG loop recordings // J. Cardiovasc. Electrophys. 2009. Vol. 20. P. 1089–1094.
  21. Norvell J.E. The aorticorenal ganglion and its role in renal innervation // J. Comp. Neur. 1968. Vol. 133. P. 101–112.
  22. Pokushalov E., Romanov A., Corbucci G., Artyomenko S., Turov A., Shirokova N., Karaskov A. Ablation of paroxysmal and persistent atrial fibrillation: 1-year follow-up throughcontinuous subcutaneous monitoring // J. Cardiovasc. Electrophysiol. 2011. Vol. 22. P. 369–75.
  23. Шабанов В.В., Романов А.Б., Артеменко С.Н., Елесин Д.В., Стерльников А.Г., Байрамова С.А., Покушалов Е.А. Определение оптимального подхода в лечении пациентов с ранними рецидивами фибрилляции предсердий после первой процедуры аблации // Патология кровообращения и кардиохирургия. 2013. № 1. С. 113–122.