Author + information
- Received November 16, 2011
- Revision received January 17, 2012
- Accepted January 20, 2012
- Published online July 1, 2012.
- Humera Ahmed, BA⁎,†,
- Petr Neuzil, MD, PhD†,
- Jan Skoda, MD†,
- Jan Petru, MD†,
- Lucie Sediva, MD†,
- Marcela Schejbalova, MD† and
- Vivek Y. Reddy, MD⁎,†,⁎ ()
- ↵⁎Reprint requests and correspondence
: Dr. Vivek Y. Reddy, Helmsley Electrophysiology Center, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1030, New York, New York 10029
Objectives This study sought to assess whether renal sympathetic denervation (RSDN) can be achieved using an off-the-shelf saline-irrigated radiofrequency ablation (RFA) catheter typically employed for cardiac tissue ablation.
Background RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension. For cardiac tissue ablation, RFA technology has evolved from nonirrigated to saline-irrigated ablation electrodes to improve both safety and effectiveness.
Methods Ten patients with resistant hypertension underwent renal angiography, followed by bilateral RSDN with a saline-irrigated RFA catheter. Ambulatory blood pressure recordings (24 h) were obtained at baseline, 1, 3, and 6 months after the procedure. Repeat renal angiography was performed during follow-up to assess for arterial stenosis or aneurysm. In 5 patients, pre- and post-procedural serum measures of renal function and sympathetic activity were obtained: aldosterone; metanephrine; normetanephrine; plasma renin activity; and creatinine.
Results Over a 6-month period: 1) the systolic/diastolic blood pressure decreased by −21/−11 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least 10 mm Hg (range 10 to 40 mm Hg); 3) there was no evidence of renal artery stenosis or aneurysm at repeat angiography; and 4) there was a significant decrease in metanephrine (−12 ± 4, p = 0.003), normetanephrine (−18 ± 4, p = 0.0008), and aldosterone levels (−60 ± 33 ng/l, p = 0.02) at 3 months. There was no significant change in plasma renin activity (−0.2 mg/l/hod, p = 0.4). There was no significant change in serum creatinine (−1 mmol/l, p = 0.4).
Conclusions These data provide the proof-of-principle that RSDN can be performed using an off-the-shelf saline-irrigated RFA catheter.
Dr. Reddy has received research grant support and has served as a consultant to Biosense-Webster Inc.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 16, 2011.
- Revision received January 17, 2012.
- Accepted January 20, 2012.
- American College of Cardiology Foundation