Author + information
- Received January 3, 2019
- Revision received April 26, 2019
- Accepted April 30, 2019
- Published online June 17, 2019.
- Pierre C. Qian, BSc(Med), Hons. MBBSa,b,c,∗ (, )
- Michael A. Barry, BSca,d,
- Juntang Lu, AdvDip(Vet)a,
- Jim Pouliopoulos, BSc, MSc(Med), PhDa,b,
- Ashraf Mina, BSc, MSc, PhDe,
- Sushil Bandodkar, BSc, MSc, PhDf,
- Shirley Alvarez, BSc(Med)f,
- Virginia James, MScc,
- John Ronquillo, BSc(Med)g,
- Winny Varikatt, MBBS, PhDg,
- Aravinda Thiagalingam, MBChB, PhDa,b,c and
- Stuart P. Thomas, MBBS, PhDa,b,c
- aCardiology Department, Westmead Hospital, Sydney, AustraliaCardiology Department, Westmead Hospital, Sydney, Australia
- bSydney Medical School, University of Sydney, Sydney, AustraliaSydney Medical School, University of Sydney, Sydney, Australia
- cThe Westmead Institute for Medical Research, Sydney, AustraliaThe Westmead Institute for Medical Research, Sydney, Australia
- dSchool of Electrical and Information Engineering, University of Sydney, Sydney, AustraliaSchool of Electrical and Information Engineering, University of Sydney, Sydney, Australia
- eNSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, AustraliaNSW Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
- fBiochemistry Department, The Children’s Hospital at Westmead, Sydney, AustraliaBiochemistry Department, The Children’s Hospital at Westmead, Sydney, Australia
- gDepartment of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, AustraliaDepartment of Anatomical Pathology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Sydney, Australia
- ↵∗Address for correspondence:
Dr. Pierre C. Qian, Department of Cardiology, Westmead Hospital, Corner of Hawkesbury and Darcy Road, Westmead, Sydney 2145, Australia.
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.
This study was supported by a Commercial Development and Industry Partnerships Fund (CDIP19-2015), University of Sydney and Western Sydney Local Health District. Dr. Qian was supported by a National Health and Medical Research Council (NHMRC) and National Heart Foundation of Australia (NHF) cofunded postgraduate scholarship (NHMRC Scholarship No. 1114408, NHF Scholarship No. 101107). Dr. Qian and Mr. Barry are inventors of the patented microwave system used in this study with intellectual property rights assigned to the University of Sydney and Western Sydney Local Health District. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 3, 2019.
- Revision received April 26, 2019.
- Accepted April 30, 2019.
- 2019 American College of Cardiology Foundation
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