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Renal Denervation Therapy (RDN) have been proven to be useful in resistant hypertension patients. The Symplicity Trials did not include patients with renal disease whereas, a significant number of end stage renal disease (ESRD) patients who have resistant hypertension despite being on multiple drugs and the benefits of RDN in such patients have not been reported.
Here we describe a series of 5 cases in which RDN was performed in patients with ESRD and resistant hypertension. The RF energy was delivered using the standard RF delivery system that is used in cardiac electrophysiology lab and a standard 5F, 4mm tip RF ablation catheter was used. Additionally multiple 3 dimensional imaging and catheter monitoring modalities were used to precisely pinpoint the site of RF energy delivery. Dyna CT, a novel 3D imaging tool was used to precisely define the anatomy and annotate the radiofrequency lesions given in a spiral fashion along the length of the arteries. In addition, non fluoroscopic anatomy was created using the NavX Version 3 system.
The procedure was completed without any complications in all 5 patients. The average procedure time was 28 min and average of 5.6 lesions was given in each renal artery. Post procedure renal parameters did not show any significant difference at 48 hrs and at 1 month followup.
There was a significant drop in blood pressure in all the patients 38 ± 18 mmHg in systolic and 16 ± 14 mmHg fall in diastolic BP at 1week follow up and 39 ± 22 mmHg systolic , 18 ± 13 mmHg fall in diastolic BP at 1 month follow up.
To the best of our knowledge, this is the first time in the world that such precision technology has been used to guide this promising new therapy. This also is amongst the first case series of renal failure patients treated with renal denervation. This is also the first report of usage of standard RF ablation catheters for renal denervation and has the potential of widespread usage in labs already equipped with EP systems without any additional expenditure.
- 2013 American College of Cardiology Foundation