6-Month Outcomes in Patients With Implantable Cardioverter-Defibrillators Undergoing Renal Sympathetic Denervation for the Treatment of Refractory Ventricular Arrhythmias

Luciana V Armaganijan; Rodolfo Staico; Dalmo A R Moreira; Renato D Lopes; Paulo T J Medeiros; Ricardo Habib; Jônatas Melo Neto; Marcelo Katz; Dikran Armaganijan; Amanda G M R Sousa; Felix Mahfoud; Alexandre Abizaid

doi:10.1016/j.jcin.2015.03.012

6-Month Outcomes in Patients With Implantable Cardioverter-Defibrillators Undergoing Renal Sympathetic Denervation for the Treatment of Refractory Ventricular Arrhythmias

JACC Cardiovasc Interv. 2015 Jun;8(7):984-90. doi: 10.1016/j.jcin.2015.03.012.

Affiliations

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.

PMID: 26088516
DOI: 10.1016/j.jcin.2015.03.012

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.

Keywords: implantable cardiac defibrillators; renal denervation; sympathetic activity; ventricular arrhythmias.

Publication types

Clinical Trial

MeSH terms

Aged
Brazil
Catheter Ablation / adverse effects
Defibrillators, Implantable*
Electric Countershock / adverse effects
Electric Countershock / instrumentation*
Female
Humans
Kidney / blood supply*
Male
Middle Aged
Prospective Studies
Renal Artery / innervation*
Risk Factors
Sympathectomy / adverse effects
Sympathectomy / methods*
Tachycardia, Ventricular / diagnosis
Tachycardia, Ventricular / physiopathology
Tachycardia, Ventricular / therapy*
Time Factors
Treatment Outcome
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / physiopathology
Ventricular Fibrillation / therapy*