JACC in a Flash | In patients with implantable cardiac defibrillators (ICDs), undergoing renal sympathetic denervation (RSD) for refractory ventricular arrhythmias (VAs) is associated with reduced arrhythmic burden without complications, according to new research published in JACC: Cardiovascular Interventions.

In this prospective, single-center trial, 10 patients at a tertiary hospital in São Paulo, Brazil, underwent RSD and were followed for 6 months. The patients had malignant VAs refractory to optimal medical therapy, with previous failed cardiac ablation or who were considered unsuitable for cardiac ablation. Six patients had Chagas disease, two had non-ischemic dilated cardiomyopathy and two had ischemic cardiomyopathy.

No patients experienced procedure-related complications. Three patients died during the follow-up time, but none of the deaths were attributed to VAs. Among surviving patients, all but one remained on beta-blockers over the 6-month follow-up period. Amiodarone was reduced in five patients and beta-blockers were reduced in two patients. No patients needed an increase in antiarrhythmic medication.

Six months prior to the procedure, the median number of ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes was 28.5 (ranging from 1 to 106). These numbers reduced to one (ranging from 0 to 17) at 1 month and zero (ranging from 0 to 9) at 6 months. The median number of Antitachycardia pacing (ATP) 6 months before the procedure was 20.5 (ranging from 0 to 52) and reduced to 0 (ranging from 0 to 7) at both 1 and 6 months after. The median number of ICD shocks 6 months prior to RSD was 8 (ranging from 0 to 88) and reduced to 0 (ranging from 0 to 3) at 1 and 6 months post-procedure. Two of the 10 patients were considered non-responders to RSD, showing no reduction in the burden of arrhythmias during follow-up.

“Our findings illustrate the relevance of sympathetic activation in patients with VA and suggest a potential role for catheter-based RSD in reducing arrhythmic burden,” the authors said. They also suggested that while more, larger studies are still needed, “RSD might become an attractive strategy for the treatment of refractory VA in patients with increased sympathetic activity.”

In a related editorial comment, Vivek Y. Reddy, MD, and Marc A. Miller, MD, applauded the study but cautioned that it is not time to “pop the champagne corks just yet.” They point out that studies currently in progress are examining the role of RSD for treatment of not only ventricular arrhythmias, but atrial fibrillation as well. Ultimately, they add, additional trials are needed “to determine whether the beneficial anti-sympathetic effects of RSD may prove effective in the control of cardiac arrhythmias.”

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Reference

1. Armaganijan LV, Staico R, Moreira DAR, et al. J Am Coll Cardiol Intv. 2015;8(7):985-90.

Keywords: CardioSource WorldNews Interventions, Defibrillators, Defibrillators, Implantable, Arrhythmias, Cardiac, Denervation, Sympathectomy, Chemical, Sympathectomy

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