Author + information
- Received February 2, 2015
- Accepted March 1, 2015
- Published online June 1, 2015.
- Luciana V. Armaganijan, MD, MHS∗∗ (, )
- Rodolfo Staico, MD, PhD∗,
- Dalmo A.R. Moreira, MD, PhD∗,
- Renato D. Lopes, MD, PhD†,‡,
- Paulo T.J. Medeiros, MD, PhD∗,
- Ricardo Habib, MD∗,
- Jônatas Melo Neto, MD∗,
- Marcelo Katz, MD, PhD, MHS‡,
- Dikran Armaganijan, MD, PhD∗,
- Amanda G.M.R. Sousa, MD, PhD∗,
- Felix Mahfoud, MD§,‖ and
- Alexandre Abizaid, MD, PhD∗
- ∗Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
- †Duke Clinical Research Institute, Durham, North Carolina
- ‡Brazilian Clinical Research Institute, São Paulo, Brazil
- §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
- ↵∗Reprint requests and correspondence:
Dr. Luciana Armaganijan, Dante Pazzanese Institute of Cardiology, Avenida Doutor Dante Pazzanese, 500, Vila Mariana, São Paulo 04012-909, Brazil.
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.
Dr. Lopes has received consulting fees and research grants from Bristol-Myers Squibb; has received research grants from GlaxoSmithKline; and has received consulting fees from Boehringer Ingelheim, Bayer, and Pfizer. Dr. Mahfoud is supported by Deutsche Hochdruckliga and Deutsche Gesellschaft für Kardiologie; has received scientific support from Medtronic/Ardian and St. Jude; was an investigator for the Symplicity HTN-1 and -2 trials; and has received speakers honoraria and consultancy fees from Medtronic/Ardian, St. Jude, Boston Scientific, and Cordis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 2, 2015.
- Accepted March 1, 2015.
- American College of Cardiology Foundation