Cardiology Letters 2016, 25(2):71-78

Radiofrequency renal sympathetic denervation in patients with resistant arterial hypertension - 12-month follow-up

Maďarič J¹, Vulev I², Fľak Ľ¹, Postulková Ľ², Škultétyová D¹, Maďaričová T¹, Hladíková D¹, Tóth M¹, Vašková J¹, Drangová E², Mikuláš J², Mistrík A¹, Chňupa P¹

¹ Klinika kardiológie a angiológie NÚSCH, a.s. a LF SZU

² Klinika diagnostickej a intervenčnej rádiológie NÚSCH a.s. a LF SZU, Bratislava, Slovenská republika

Aims: To evaluate safety and efficacy of percutaneous radiofrequency renal sympathetic denerv­ ation (RDN) in patients with resistant arterial hypertension (AH) in mid-term follow-up.

Methods: In the group of 21 patients (age 54±10 years, M:F 13:8) with inadequately controlled AH on ≥3 com­ bination of antihypertensive treatment including diuretics (average office blood pressure (BP) 187/112 mmHg with average number of antihypertensive drugs 7±1), we performed RDN intervention in analgosedation via transfemoral percutaneous approach with the use of RDN Symplicity catheter and EnligHTN catheter. During the 12 months follow-up period we analyzed changes in office BP, ambulatory BP monitoring (ABPM), as well as presence of complications. Patients with decrease in office systolic BP ≥10mmHg were defined as responders to RDN.

Results: Global or local complications linked to intervention were not detected. The change in renal filtra­ tion did not occur, and we did not register renal artery stenosis on control CT angiography 3 months after RDN. One patient died 11 months after RDN due to acute myocardial infarction. In 20 observed patients a significant decrease in office BP 12 months after RDN was present (sBP 187±20 vs 162±32mmHg, p=0.002; dBP 112±20 vs 97±20mmHg, p=0.0006), however only a borderline decrease of ABPM values was reached (sTK 169±16 vs 163±30mmHg, p=0.13). Target decrease of office BP 12 months after RDN was achieved in 15/20 patients (75%). The number or dosage of antihypertensive drugs was reduced in 10/20 patients (50%). In the subgroup of 11 patients (55%) the decrease in ΔsBP>20mmHg together with ΔABPM sBP >15mmHg with average drop in office BP -51/-26mmHg and ABPM -23/-9mmHg was achieved ("super-responders"). Responders on RDN were characterized by higher values of office BP before RDN (191±21 vs 175±15mmHg, p=0.04), lower values of ABPM before RDN (149/80 vs 165/97mmHg, p<0.05), and by a higher number of ablation points (12.5±2.7 vs 10.2±1.1, p=0.009), compared to non-responders.

Conclusions: Radiofrequency renal sympathetic denervation is a safe method achieving significant decrease in office BP, though only with borderline drop in ABPM, in patients with resistant AH during the one year follow-up period. An increase in number of responders to RDN could be expected after the introduction of a better generation of ablation catheters, and mainly after identification of proper a phenotype of resistant AH for RDN procedure.

Keywords: resistant arterial hypertension; renal sympathetic denervation; radiofrequency ablation interventional procedure

Published: February 1, 2016  Show citation