Hints of renal-denervation side benefit: Fewer ventricular arrhythmias
San Francisco, CA - While renal denervation achieved its goals of lowering blood pressure and heart rate in a small series of especially high-risk patients with drug-resistant hypertension, it also lessened their burden of ventricular and supraventricular arrhythmias, according to researchers presenting this week at the American College of Cardiology 2013 Scientific Sessions [1].
The findings add to evidence that the investigational catheter-based procedure for alleviating high levels of sympathetic activation can, beyond simply lowering blood pressure and heart rate, lessen associated myocardial damage and secondary effects such as arrhythmias.
In the current series of 14 patients with hypertension despite taking a mean of 4.5 antihypertensive agents, many with diabetes and most with left ventricular hypertrophy, the frequencies of premature ventricular contractions (PVCs) and ventricular and supraventricular arrhythmias on 24-hour Holter monitoring decreased significantly within a month of renal denervation.
In perhaps this "first study to show that renal denervation can have an effect on ventricular arrhythmias," the patients had greater-than-usual sympathetic activation and higher initial blood pressures than seen in some renal-denervation studies and were at greater arrhythmic risk, according to coauthor Dr Vasilios Papademetriou (University of Athens, Hippokration Hospital, Greece). That, he told heartwire, explains how they were able to achieve greater-than-typical reductions in blood pressure and probably why reductions in ventricular arrhythmias have been seldom seen after the procedure, at least in the literature.
Results of renal denervation therapy in 14 patients with drug-resistant hypertension
| Parameter | Baseline | 1 mo post-renal denervation | p |
| PVCs/h (mean) | 2.23 | 0.39 | 0.02 |
| PSVCs/h (mean) | 1.62 | 0.72 | 0.04 |
| Mean in-office measurements | |||
| Systolic BP (mm Hg) | 179.4 | 141.4 | <0.001 |
| Diastolic BP (mm Hg) | 95.0 | 80.9 | 0.003 |
| Heart rate (bpm) | 75.8 | 68.7 | 0.047 |
| Means at 24-h monitoring | |||
| Systolic BP (mm Hg) | 151.7 | 133.7 | <0.001 |
| Diastolic BP (mm Hg) | 85.9 | 76.4 | 0.001 |
| Heart rate (bpm) | 72.1 | 66.6 | 0.026 |
Five of the 14 patients had complex ventricular arrhythmias at baseline, including four with ventricular couplets and one with nonsustained ventricular tachycardia; only two of the five demonstrated such arrhythmias a month after renal denervation.
The same numbers applied to episodes of paroxysmal atrial fibrillation: five patients showed them at baseline, and they could be demonstrated in only two at one month.
Total numbers of premature ventricular and atrial contractions went down significantly as well.
Interestingly, Papademetriou said there was no correlation between reductions in premature ventricular and supraventricular contractions and the decreases in blood pressure after renal denervation.
Источник: www.theheart.org
